Court of Protection judge orders haemodialysis for man with dementia
The case of Re: CD (Treatment: Haemodialysis) is a recent case of note that will be relevant to health and care professionals concerned with mental capacity and decisions on medical treatment.
Background
The Court of Protection heard the case of CD, a 66-year-old man suffering from end-stage renal disease as well as other health conditions. One of these health conditions being dementia, which caused CD to lack capacity.
CD was an in-patient at a hospital operated by the Applicant Trust. CD had a temporary catheter in place and had previously removed his temporary catheters on several occasions. CD also removed his tunnelled catheter.
After the latter incident, clinicians inserted a temporary catheter under sedation but were of the view that insertion of another tunnelled catheter was not in CD’s best interests.
The view of the Applicant Trust
The Applicant Trust considered continued dialysis and the insertion of a tunnelled catheter not to be in CD’s best interests. They were of the view that palliative care was the appropriate course of action at CD’s stage of the disease.
The Applicant Trust raised concerns over the risks to CD in proceeding with the installation of a tunnelled catheter, including risk of a stroke. They also highlighted that CD’s removal of his catheter places him at risk of blood loss and infection and, if CD removed his tunnelled catheter during dialysis, it could pose a threat to life.
However, they agreed that if the court found the treatment to be in CD’s best interests, then the risk was not so unsafe that the procedure should not be carried out upon the order of the court.
The view of CD’s family and his litigation friend, the Official Solicitor
CD’s family agreed with the medical evidence provided in relation to CD’s condition. However, they were of the view that CD would want to continue treatment and were supportive of this as being in CD’s best interests.
The court heard the family provide an account of CD as a man who still enjoyed life and time with his family. They also drew attention to CD’s dedication to his Muslim faith. As a Muslim, CD would not have wanted to suffer an intolerable burden, however, they told the court that CD’s hardships were not so great as to suggest he would not want to continue living.
So, what did the judge conclude?
The court found that it was in CD’s best interests to have a tunnelled catheter fitted and continue with the dialysis, allowing reasonable force or general anaesthetic to do so.
The court had regard to the 2013 Aintree v James decision which found a presumption in favour of preserving life, however this presumption is not absolute. This court showed its position to be based on an assessment of the balances between the burdens of treatment and the need to preserve life.
The court did not believe that the burdens to CD put forward by the Trust were so significant as to outweigh the chance to preserve his life, in line with paragraph 5.31 of the Mental Capacity Act Code of Practice.