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(Court of Protection, Eleanor King J, 24 May 2013)
The 22-year-old man was born with holoprosencephaly (HPE), a congenital abnormality of the brain. The condition was extremely rare, progressive and ultimately fatal. He suffered from cerebral palsy, severe learning difficulties and was unable to walk. From a young age he had been cared for by a foster carer who was for all purposes his psychological mother.
The man's health began to deteriorate in 2010 and required repeated hospital admissions. The medical evidence now was that the man's condition had progressively and irreversibly deteriorated with profound muscle loss and an inability to maintain adequate nutrition. It was likely the situation would further deteriorate leading to respiratory failure. At that point it would be extraordinarily unlikely that he would recover even with ventilation in intensive care.
The NHS Trust took a best interests decision that the man should not be resuscitated and sought declarations from the court that he should not be resuscitated, should not receive intensive care treatment (specifically that he should not be mechanically ventilated), and should not be given antibiotics in the event of contracting pneumonia. The mother agreed in relation to CPR but thought he should otherwise be given every chance to recover.
It was agreed by all parties that the man lacked capacity to litigate and to make the medical decisions before the court. In all of the circumstances it was in the man's best interests for CPR to be withheld. He would inevitably continue to deteriorate even if CPR were successful. CPR would be futile and would in all likelihood lead to rib fractures, further loss of cognitive function and mechanical ventilation.
In the case of immediately reversible conditions for which treatment would have a therapeutic benefit it would be in his best interests to receive such treatment. However, where intensive care and/or ventilation were considered there would be no therapeutic benefit and no prospect of a cure of his condition. It would also subject him to unnecessary discomfort and indignity. The orders sought by the NHS Trust would be granted.