British Court Rules That Competent & Conscious Patient Can Be Denied Life-Sustaining Treatment

[Stone]

British Court Rules That Competent & Conscious Patient Can Be Denied Life-Sustaining Treatment Against Her Will

ZH |  SEP 04, 2023
Authored by Jonathan Turley

In my torts class, I often compare the different approaches and doctrines in the United States and the United Kingdom.

One of the most pronounced is the position and authority of physicians on issues like consent and malpractice. This week produced a particularly striking example.

British doctors are seeking to take a 19-year-old critically ill female patient off the intensive care despite her objections and those of her parents.

Unlike most such cases, the woman known only as “ST” is conscious and communicative.

Yet, the doctors argue that she is not being realistic about her chances of survival from a rare disorder.

Now a British court has agreed and ordered that she can be placed on end-of-life care against her will.

ST is suffering from a rare genetic mitochondrial disease that is progressively degenerative. The case has similarities to that of Charlie Gard, an infant who was removed from life support at the insistence of doctors despite objections from the parents. The Gard family was seeking to take Charlie to the United States for experimental treatment.

ST has been in the ICU for the past year, requiring a ventilator and a feeding tube. She also requires regular dialysis due to chronic kidney damage from her disease.

She wants to be allowed to travel to Canada for an experimental treatment but the doctors oppose the plan and say that she is not accepting the realities of her terminal illness.

They say that she is “actively dying” without any hope of resuming life outside of intensive care.

Her deeply religious family have spent their entire life savings on her care and has complained that a “transparency order” requested by the hospital barred their ability to give details on the case to help raise public funds.

What is so remarkable about this case is that it is not an infant or a comatose patient.

The court found that ST “is able to communicate reasonably well with her doctors with assistance from her mother and, on occasion, speech therapists.”

Moreover, two psychiatrists testified that she is mentally competent to make decisions about her own care.

Despite all the difficulties which currently confront her, ST is able to communicate reasonably well with her doctors with assistance from her mother and, on occasion, speech therapists. Over the course of the last week she has engaged in two separate capacity assessments. I heard evidence from two consultant psychiatrists whose conclusions in relation to her capacity in both domains are set out in full written reports. . . .

She has been described by those who know and love her as “a fighter”. That is how she sees herself. At the heart of the issues in this case is what ST and her family perceive to be a ray of hope in the form of an experimental nucleoside treatment outside the United Kingdom which might offer her hope of an improved quality of life, albeit a life which is likely to end prematurely in terms of a normal life expectancy. She has told her doctors that she wants to do everything she can to extend her life. She said to Dr C, one of the psychiatrists who visited her last week, “This is my wish. I want to die trying to live. We have to try everything”. [Court’s emphasis] Whilst she recognises that she may not benefit from further treatment, she is resistant to any attempt to move to a regime of palliative care because she wants to stay alive long enough to be able to travel to Canada or North America where there is at least the prospect that she may be accepted as part of a clinical trial. . . .

ST is well aware that she has been offered a very poor prognosis by her doctors. She acknowledges that they have told her that she will die but she does not believe them. She points to her recovery from previous life-threatening episodes whilst she has been a patient at the intensive care unit. She believes she has the resilience and the strength to stay alive for long enough to undergo treatment abroad and she wishes the court to acknowledge her right to make that decision for herself.

Nevertheless, the judge found that she is mentally incapable of making decisions for herself because “she does not believe the information she has been given by her doctors.”

The court appears to reject her ability to make this decision because she is making the wrong decision:

In my judgment . . . ST is unable to make a decision for herself in relation to her future medical treatment, including the proposed move to palliative care, because she does not believe the information she has been given by her doctors. Absent that belief, she cannot use or weigh that information as part of the process of making the decision. This is a very different position from the act of making an unwise, but otherwise capacitous, decision. An unwise decision involves the juxtaposition of both an objective overview of the wisdom of a decision to act one way or another and the subjective reasons informing that person’s decision to elect to take a particular course. However unwise, the decision must nevertheless involve that essential understanding of the information and the use, weighing and balancing of the information in order to reach a decision. In ST’s case, an essential element of the process of decision-making is missing because she is unable to use or weigh information which has been shown to be both reliable and true.

Accordingly, the court ruled that decisions about ST’s further care should be determined by the Court of Protection based on an assessment of her best interests. Her “best interest,” according to the doctors, is to die.

Thus, the courts have declared that ST cannot choose to continue life-extending treatment and can be forced into palliative care against her will.

The logic of the decision is chilling.

The court is told that ST has cognitive and communicative abilities to make such decisions. However, because the court disagrees with her desire to continue to fight to live, she is treated as effectively incompetent.

It seems like the judicial version of Henry Ford’s promise that customers could pick any color car so long as it is black.

Here is the opinion: In the Matter of ST

[Stone]

UK teen dies after courts refused to consider lifesaving treatment
The young woman's parents remain bound by a court-enforced gag order that prevents the identity of individuals involved in the case from being revealed.

Sep 14, 2023
(LifeSiteNews - adpated) — A conscious 19-year-old denied life-saving treatment by a judge who considered her “delusional” for wanting to fight for her life has died. Her grieving family is still forced to adhere to strict reporting restrictions and the girl’s identity remains unknown.

The young British woman, known as “ST” due to court-enforced gag orders that prevent individuals involved in the case from being identified, died Tuesday in the U.K. after suffering cardiac arrest. Although she suffered her entire life from mitochondrial depletion syndrome — a rare genetic condition in which the energy-producing mitochondria are severely deficient in the body’s cells — the girl’s health had significantly deteriorated after contracting COVID-19 in August 2022.

For the last year of her life, ST was in the intensive care unit on a ventilator and dialysis, which a judge ruled could be removed by the hospital, citing unsubstantiated claims that the girl was unable to make her own medical decisions.

Despite the reality that the case surrounding ST’s end-of-life treatment has undoubtedly concluded after her tragic death, the reporting restrictions that allow courts to keep all information in cases related to the 2005 Mental Capacity Act private have not been lifted. The same restrictions prevented her from fundraising money to travel to the United States and Canada for experimental treatments in which she had expressed a desire to participate.

“We lost our beautiful and courageous daughter, known to the world as ST,” the girl’s parents told the Daily Mail. “To us she has a real name.”

“To her family, she was everything and we will cherish and never forget the 19 years we had with her. The past year, however, has been one of struggle, even torture, for ST and for her family and the hands of the hospital and the Court of Protection.”

“We were essentially given a choice: give up and let us prepare your daughter for death, or have your lives dismantled and torn apart if you wish to resist us,” the family continued. “We chose to give up everything for our daughter. Day after day in the intensive care ward we and ST had to exist in an environment that had given up on her right and wish to live.”

ST herself had told the outlet last week that “I do not want this and want to try the treatment being offered abroad,” which she described as “my only chance” even though “it might only be a small chance.”

The family added that the fight for their daughter’s “right to be identified and for her full story to be known” is one that they will continue even after her death. However, as noted by the Daily Mail, “they are now struggling to find the funds to pay off their debts and cover the costs of ST’s funeral.”

They were forced to pay legal fees on their own, sacrificing £25,000 in savings and “giving up their livelihoods” to never be separated from their daughter and sister. Recently, the Christian Legal Centre began supporting the family with the legal battle free of charge.

As previously reported by LifeSiteNews, ST was deemed unable “to accept the medical reality of her position” due to her hope that she might find lifesaving treatment beyond the U.K. on August 25. Mrs. Justice Roberts made the decision after the University Hospital Birmingham NHS Foundation Trust filed a case seeking authorization from the Court of Protection to stop life-saving treatment and shift to palliative care.

Medical professionals not in favor of supporting ST’s fight for her life described her hope and determination as a “delusion.”

Roberts argued that “her profound inability to contemplate the reality of her prognosis, and a fundamentally illogical or irrational refusal to contemplate an alternative are all likely to have contributed to impaired functioning … render[ing] her unable to make a decision for herself in relation to her future medical treatment.”

Although mental health professionals testified that the girl’s cognitive abilities were unaffected by her physical deterioration, the decision authorized the hospital to remove dialysis and avoid any attempts to resuscitate her.

Last week, British television star and politician Laurence Fox publicly criticized the ruling that sided with the National Health Service (NHS) trust, calling it “satanic insanity.”

“The silencing of the family’s freedom of speech to speak about the case is an even starker wrong,” he added, emphasizing that the judge’s decision was “the removal of the ultimate freedom — that of life.”

Anglican Reverend Calvin Robinson expressed similar sentiments, saying he was willing to break the reporting restrictions to be able to help the family. He told LifeSiteNews that “no human law can override natural law or divine law,” arguing that the restrictions are a form of “censorship.”

Robinson said earlier this week that, should ST contact him for assistance, he would have been willing to break the “immoral law” that was denying her not only crucial medical treatment but also financial and spiritual support.