Cambridge University Hospitals NHS Foundation Trust v AH & Ors (Serious Medical Treatment) [2021] EWCOP 51

Judgment concerning whether the mechanical ventilation of a woman lacking capacity should be discontinued.

AH is a 56-year-old woman who is an inpatient at a Cambridge Hospital where she is dependent on ventilatory support and unable to communicate her own self-generated thoughts. AH was admitted to the hospital in December 2020 on an emergency basis with severe Covid-19 symptoms. These led to neurological complications which make AH “the most complex Covid patient in the world.” The central question before the Court was whether AH’s mechanical ventilation should continue. The parties agreed that AH lacks the capacity to give or refuse consent for medical treatment. However, AH’s family members advanced a wide range of views about how to respond.
 
Hayden J, agreeing that AH lacks the capacity to provide consent, held that continued ventilation would not be in AH’s best interests. He based his decision on the futility of AH’s treatment
 
“she is dying slowly in both physical and emotional pain; her treatment is burdensome and exhausting; her rest is of necessity frequently interrupted and she is on a small noisy mixed-gender ward which affords her minimal privacy and fails satisfactorily to respect her cultural norms (this is unavoidable at present), her dignity is preserved by the tireless efforts of her doctors, the rigorously attentive care of the nurses, the sensitive and intimate care given by her daughter M, which is focused not only on her mother’s comfort but on her presentation to the world and more generally, the love of her children and family, which is fiercely strong and entirely unconditional. AH’s dignity, however, hangs by a thread.”
 
Hayden J also held that the possibility of ventilation outside of the ICU was medically unsafe as it risked an “avoidable, painful unexpected death”.
 
When considering AH’s wishes and feelings, Hayden J held that the ventilation should remain in place until all of her children and family members could be with her as the evidence indicated that this is what she would want; even if this meant the “continuation of burdensome and futile” treatment for a period.

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