Wye Valley NHS Trust v B (Rev 1) [2015] EWCOP 60 – Individual autonomy succeeds against medical advice as to a patient’s best interests

The Court of Protection has ruled that a mentally incapacitated man can refuse lifesaving treatment.

Mr. B, a diabetic with a severely infected leg, refused amputation. Doctors treating Mr. B wished to perform such operation in order to save his life.  The court noted that ‘’without the operation, the inevitable outcome is that he will shortly die, quite possibly within a few days. If he has the operation, he may live for a few years’’ (para 1).

The court considered the principles of section 1 and 2 Mental Capacity Act 2005 and the authorities notably Aintree University Hospitals NHS Trust v James [2014] AC 591.

The Judge was satisfied that Mr B did not have capacity to make decisions (para 34). However, on the balance of interest test, the court considered that it would not be in Mr B’s interest to have the operation. Mr Justice Peter Jackson stated ‘’ I am 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’’ (para 45).

Mr Justice Jackson visited Mr B as to his needs and wishes. It was noted that mental illness of Mr B resulted in him having religious delusions. Despite these being delusions, the Judge noted the importance of religion to him.

The court stated ‘’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. 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’’ (para 43).

The case demonstrates the importance of a person’s right to autonomy and the weight that this should hold. Despite evidence of mental illness, the Judge stated that ‘’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’’ (para 43).