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The Court of Protection has ruled that it is in the best interests of an 18-year-old man to undergo complex spinal surgery to correct a progressive curvature of his spine, despite the significant risks involved. The judgment highlights the careful balancing exercise required where a patient lacks capacity to consent to medical treatment.
Background to the Case
The young man suffered from progressive scoliosis, alongside a number of other medical conditions. He had complex learning disabilities and limited communication abilities, and it was clear that he lacked capacity to make decisions about his medical treatment.
In recent years, his scoliosis had worsened considerably. Surgical correction was proposed, but due to his disabilities, he would be unable to cope with the pain and immobility following surgery. Medical evidence confirmed that he would be likely to remove dressings, dislodge monitoring equipment and interfere with medication lines.
As a result, the only viable post-operative option would involve heavy sedation and mechanical ventilation for an estimated period of two to three weeks. Given the seriousness of the decision, an application was made to the Court of Protection.
Medical Evidence and Risks
The Court considered detailed medical evidence addressing both the surgery and the proposed post-operative care. The evidence identified:
- a 10 per cent risk of death;
- a 30-40 per cent risk of serious complications, potentially extending time in intensive care; and
- the likelihood that successful surgery would increase life expectancy by 5-10 years.
Without surgery, the man’s scoliosis was expected to worsen, with further deterioration in lung function. Medical professionals advised that he would be unlikely to live beyond his late twenties without intervention.
Family’s Perspective
The man’s mother told the Court that her son was an active young man who enjoyed life and especially valued time with his family. However, his condition had begun to significantly limit his comfort and mobility. He struggled to sit upright, became breathless more easily and could not maintain the same position for more than a few minutes without pain.
Having listened to the medical evidence, she supported the surgery, believing it to be in her son’s best interests.
Court’s Best Interests Analysis
The Court emphasised that the case involved a stark choice. There was no conservative treatment available and no safe way to perform the surgery without intensive post-operative care. The options were therefore limited to surgery with sedation and ventilation, or no treatment at all.
The Court found that:
- the surgery was more likely than not to be successful;
- it would reduce the spinal curvature by approximately 50 per cent;
- it would improve mobility and halt progression of the condition; and
- without surgery, the man faced a significantly shortened life expectancy.
The Court considered that the man clearly enjoyed life and would wish to continue living and spending time with his family, provided he was not subjected to excessive pain or distress. A successful operation would enable this.
Balancing all the factors, the Court concluded that it was in the man’s best interests to undergo the proposed spinal surgery and associated post-operative care.
Q&A: Medical Treatment Decisions and the Court of Protection
What is the Court of Protection?
The Court of Protection makes decisions on behalf of individuals who lack mental capacity, including decisions about serious medical treatment.
How does the Court decide what is in someone’s best interests?
The Court considers medical evidence, the person’s wishes and feelings (so far as they can be ascertained), the views of family members and the likely benefits and burdens of treatment.
Does a high level of medical risk prevent treatment being approved?
Not necessarily. The Court will weigh the risks against the potential benefits and the consequences of not providing treatment.
Can family members influence the decision?
Yes. The views of close family members are an important part of the best interests assessment, although they are not determinative.
Why was surgery approved in this case?
Because it offered significant benefits, including improved quality of life and increased life expectancy, and the alternative was likely premature death.