Judge rejects call to give life-saving treatment against opposition of patient

A Court of Protection judge has ruled that it would be unlawful for an NHS trust to carry out life-saving treatment against the patient’s opposition.

In Wye Valley NHS Trust v B [2015] EWCOP 60 the issue was whether it was lawful for doctors treating Mr B, a 73-year-old man with a severely infected leg, to amputate his foot against his wishes in order to save his life.

Mr B had a long-standing mental illness that deprived him of the capacity to make the decision for himself.

The operation could therefore only be lawfully performed if it was in his best interests, so the NHS Trust applied to the court.

A hearing took place before Mr Justice Peter Jackson on 24 September, with expert evidence given. The judge visited Mr B in hospital the following day. He then received further submissions from the parties.

Refusing to grant the NHS trust’s application, Mr Justice Peter Jackson emphasised that the effect of his decision was not that it would be unlawful to carry out the operation, rather that it would be unlawful to carry it out against Mr B's opposition.

“Given his views on life and death, it is very unlikely that he will change his mind,” the judge said. “But if he does, there is nothing to prevent the operation taking place, unless it is by then too late.”

Mr Justice Peter Jackson said that, having considered all of the evidence and the parties' submissions, he had reached the clear conclusion that an enforced amputation would not be in Mr B's best interests.


”Mr B has had a hard life. Through no fault of his own, he has suffered in his mental health for half a century. He is a sociable man who has experienced repeated losses so that he has become isolated. He has no next of kin. No one has ever visited him in hospital and no one ever will,” the judge said.

“Yet he is a proud man who sees no reason to prefer the views of others to his own. His religious beliefs are deeply meaningful to him and do not deserve to be described as delusions: they are his faith and they are an intrinsic part of who he is. I would not define Mr B by reference to his mental illness or his religious beliefs. Rather, his core quality is his ‘fierce independence’, and it is this that is now, as he sees it, under attack.

“Mr B is on any view in the later stages of his life. His fortitude in the face of death, however he has come by it, would be the envy of many people in better mental health. He has gained the respect of those who are currently nursing him.”

The judge he was “quite sure that it would not be in Mr B's best interests to take away his little remaining independence and dignity in order to replace it with a future for which he understandably has no appetite and which could only be achieved after a traumatic and uncertain struggle that he and no one else would have to endure.

“There is a difference between fighting on someone's behalf and just fighting them. Enforcing treatment in this case would surely be the latter.”

Mr Justice Peter Jackson said the application had been rightly brought, but should be dismissed.

David Lock QC of Landmark Chambers appeared for Mr B, instructed by the Official Solicitor.

Lock said: “The case has considerable legal significance because, on the particular facts, the Judge did not apply a presumption in favour of prolonging life but instead upheld the wishes and feelings of a person who lacked capacity.

“In previous cases Judges have almost invariably approved life-saving medical treatment despite the opposition of a patient who lacked capacity. In this case Peter Jackson J decided that it would not be in Mr B’s best interests to force him to have surgery against his wishes because his wishes should be respected.”

Vikram Sachdeva from 39 Essex Chambers appeared for the NHS Trust, which is understood to be considering whether to take the case to the Court of Appeal.