This afternoon I attended an "urgent" Court of Protection hearing via video-link.

Another amputation case.

A 43 year old man, FA, gangrene in both feet, at risk of fatal septicaemia.

He's consistently stated he doesn't want double amputation, as surgically recommended.
This is so similar to another case (ZA) I blogged about today

Both have paranoid schizophrenia, diabetes + severe infections

Both are refusing amputation.

ZA was heard by Cohen J (judgment tomorrow)

FA was heard by Hayden J + he gave oral judgment

openjusticecourtofprotection.org/2021/04/29/cou…
FA was in court throughout the hearing, propped up on pillows in bed on a hospital ward, with his solicitor by his side.

He was represented in court by Katie Gollop (via the Official Solicitor). @katiegollop

The Trust was represented by Rhys Hadden.
FA's solicitor had spoken with him for 1.5 hours and reported his views.

He would find amputation "devastating" and "totally disfiguring". He would feel "very bad" and said he'd "never get used to it".
She'd explained he would have rehab, support + counselling.

"These people will come and go and at the end of the day I am the person who will bear the brunt of it. I don't want to be in such a situation"
What if he knew for sure he would definitely die if he didn't accept the amputation?

"So be it. I am being treated as if I have no understanding. I have a very rational understanding. I do not want the amputation because the limiting effects will be too profound"
He would like to explore other treatment options + believes (falsely, say doctors) that there's a high chance of the antibiotics working.

Mr Justice Hayden met privately with FA in lunch break and found him "alert, articulate, engaged and even humorous"
But Hayden J found that FA "was unable to accept the reality and + extent of this severe, dangerous + life-threatening infection or properly to evaluate the appropriate treatment", so lacks the capacity to make his own decision.

As with ZA then, it's a best interests question.
Hayden said, "We know more about FA now at 3pm than we did at 11.30 this morning when we started the hearing. We know something of the code by which he lives his life."

Trust now took position that amputation was NOT in FA's best interests in the light of evidence of his views.
"Many individuals given this awful choice would go down the route of a double amputation and find a quality of life in it," said Trust. "He's not that person"

OS said FA was clear about his choice to IMCA + solicitor.

He's asked about appeal if judge makes wrong decision.
OS "does not wish to dissuade [judge] from a finding that FA lacks capacity".

Takes position that amputation is NOT in FA's best interests

With some trepidation, OS mentions Article 3 Human Rights Act - "inhuman or degrading treatment" (because of how FA feels about amputation)
Hayden J: To impose an amputation, doubly, on a man who doesn't want it is, I think, arguably, inhuman and degrading but that's not how FA talks about it. He says "destroy his life ambitions + goals" +"loss of opportunities". Some might use Art 3 language, but FA doesn't here.
After closing submissions FA addresses court

"Any decision to amputate my legs will have a devastating effect on my life.I do not lack capacity.I have considered everything that has been said. I've decided I do not want amputation. I would be grateful if you will abide with me."
In oral judgment Hayden gave great weight to FA's wishes "expressed unambiguously and consistently".

Quoted Baroness Hale in Aintree

supremecourt.uk/cases/uksc-201…
Hayden also read out para 10 from Lord Peter Jackson's decision in the Wye Valley NHS Trust v B case.

bailii.org/ew/cases/EWCOP…
Hayden said, "I respectfully agree with those observations [from Wye Valley judgment]. This is a fundamental issue of the rights of people with disabilities and a crucial facet of ensuring that their autonomy is protected"

FA's view "carry very significant weight indeed"
Hayden J: "There is always a strong presumption in favour of preserving life - but the determinative factor here is FA's resistance to that proposed course. .... I should be failing him if I failed to respect that."
Hayden J: "I am prepared to declare that it is not in FA's best interests to undergo amputation. At the end of the day that was the unanimous perspective of all the professionals".
Will similar weight be given to ZA's refusal of amputation?

Judgment
3pm Friday 30th April (via MS Teams)
Email: rcj.familyhighcourt@justice.gov.uk
Ask for access to COP 13718293Re: ZA before Cohen J

#NotSecretCourt

Background:
openjusticecourtofprotection.org/2021/04/29/cou…

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More from @KitzingerCelia

20 Apr
A fractious hearing today!

Counsel accused of "a charade, a game"; counter-claims "a tactical move".

We've had "my learned friend is simply wrong..." and "my learned friend has misrepresented my position".

Judge says "I can't give this case very much more of my time".
Judical eyebrows were raised: "this debate is becoming increasingly unedifying" he says, as parties "have locked horns".
Judge limits witness statements to 15 pages. They are now talking about fonts: "you can get about 30% more on the page with Aerial narrow".

Judge says 12 point Times Roman. And double spaced.
Read 6 tweets
12 Feb
Today I cried in court. I was watching 3 lovely, articulate, passionate young women (the older 2 just out of their teens) come to terms with the fact that their Dad was going to die. Doctors believed that continuing life-sustaining treatment was not in his best interests.
The family hoped+believed he would recover. There was a WhatsApp video his wife + brother believed showed P responding to them. Doctors (incl. independent expert) said no - it was involuntary movement. P is in a coma with catastrophic brain (stem) injury following stroke.
The applicant Trust was represented by Nageena Khalique QC @serjeantsinn seeking withdrawal of ventilation (+ provision of palliative care). P's brother (rep by @CounselTweets) argued for continuation of life-sustaining treatment. Official Solicitor (for P) was @DrBridgetDolan
Read 36 tweets
27 Jan
Today's hearing was about RS who is 30. Four months ago he was diagnosed with testicular cancer. His left testes was removed, but the cancer has spread. Without treatment he'll die within a year. With usual t'ment, a 95% chance of cure. Trust referred RS to palliative care only.
His mother advocated for him. Best interests meeting was convened. Agreed usual treatment ("BEP" - Bleomycin, Etoposide, Platinum (Cisplatin) chemotherapy) is not suitable for RS. He'd need to be under GA for 70+ hrs due to inability to tolerate clinical intervention.
RS has Fragile X syndrome, atypical severe autism, learning disability + limited communication. But described by his consultant oncologist as "a fit lad with no physical difficulties".
Read 18 tweets
25 Jan
Today's hearing concerned a Trust's application for approval of an order for a 63 year old man with learning disabilities to be given a trans-urethral resection of the prostate (TURP) - using chemical or physical restraint if necessary.
nhs.uk/conditions/tra…

#NotSecretCourt
He's terrified of hospitals because "that's where my Dad died". He currently has a catheter in place but that needs changing every 3 months with all the difficulties occasioned by a hospital visit. A TURP would fix the urinary problems once and for all.
Mr Justice Hayden is superb today. A clear + unwavering focus on P. "I'm eager to ensure the TERP is undertaken on the basis of clinical need, rather than due to the challenges of getting P to hospital. How do I satisfy myself of that?"
Read 15 tweets
15 Jan
Does being watched change how justice is done? Lawyers in the Court of Protection say it does. Here are the top 5 ways.

Are there more? Comments welcome!

[1] Cases are opened properly with case summaries highlighting history of case + key issues + introduction to the parties.
[2] Role of observers is now routinely raised with P + P's family Responses include "acute distress", "mild anxiety", "neutrality", "active desire for observers + journalists to publicise injustice". Solicitors may need to become more skilled at these convos. + explaining TO.
[3] Taking more time to expressly set out legal basis underpinning hearing (human rights + MCA). Lawyers' views vary from "as the principles are pushed to the forefront of everybody's mind, they are more rigorously and consistently applied" to concern about extra time taken.
Read 7 tweets
14 Jan
I've spent most of today in court watching an urgent application before Mrs Justice Judd concerning a feeding tube for a woman (P) in her 70s with Lewy Body dementia. She's in hospital following admission in November last year with biliary sepsis + delirium.
She's had a rough time in hospital. Pneumonia, surgery for gallstones + Covid for which she needed oxygen. All this combined to mean she can't swallow + nasogastric tube is now dislodged. Trust don't think replacement replacing it is in her best interests.
Family disagree. Describe P's good quality of life - loved, cared for, supported, communicating with family + doing Times crossword up until a few weeks before hospital admission. Family says this is not "severe" dementia + treatment should not be withdrawn
Read 14 tweets

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