Aintree University Hospital NHS Foundation Trust v James: Best Interests and Futility under the Judicial Microscope
14 Nov, 13 | by BMJ
Guest post by Daniel Sokol, barrister at 12 King’s Bench Walk / King’s College London.
Eight years after coming into force, the Mental Capacity Act 2005 has finally reached the scrutiny of the Supreme Court in Aintree University Hospital NHS Foundation Trust v James  UKSC 67.
David James was a professional musician, and a family man. He had three children, three grandchildren, and many friends. In May 2012, he acquired an infection in hospital which resulted in his admission to the critical care unit. He was put on a ventilator. In the following months, his condition fluctuated. At one point, his heart stopped and he required 6 minutes of CPR. He later underwent a tracheostomy, and received artificial nutrition and hydration. Two months after his admission in hospital, he lost the capacity to make decisions about his medical treatment. In spite of this, Mr James was able to recognise his wife and son, to kiss them, to follow their movements with his eyes, and, on occasion, to smile. His prospects of leaving the hospital were nonetheless slim.
In September 2012, the hospital sought a number of declarations from the Court of Protection, one of which was that it would be in Mr James’ best interests not to receive certain treatments, including CPR, in the event of his deterioration. The family disagreed. They felt he still enjoyed life and that, each time he contracted an infection, he managed to pull through.
The judge at first instance refused to make the declarations. He did not consider the treatments to be futile or unduly burdensome.
The hospital trust appealed to the Court of Appeal. By then, Mr James’s condition had deteriorated dramatically. He was comatose, or semi-comatose, and completely ventilator-dependent. The Court allowed the appeal and made the declarations. On 31st December 2012, Mr James suffered a cardiac arrest and died.
Mr James’s widow appealed to the Supreme Court. more…