Nottingham University Hospitals NHS Trust v JM & Anor [2023] EWCOP 38

Urgent application concerning medical treatment where the P, JM, is refusing dialysis

JM is a 26 year old man with a diagnosis of autism and whose early life was marked by trauma. In 2021 he was diagnosed with chronic kidney disease requiring regular at least 4 hourly sessions of haemodialysis for a minimum of three times per week; he will die within 8-10 days, if he does not receive treatment. A succession of medical events and admissions, often involving restraint, culminated in this urgent application after JM severed his dialysis line and refused to have a new one inserted.

Hayden J notes at [24] that JM does not believe he will die should he refuse dialysis but at [28] Hayden J also notes that forcing him to undergo the process may  'retraumatise him. In my judgement, it would compromise JM's dignity' before concluding at [44]

"JM's belief system in respect of dialysis is so plainly distorted as to manifestly rebut the presumption of capacity, erected by the MCA 2005. However, even though his reasoning is unsound, JM's confidence and belief in his own judgment is well-established and as the chronology of the case has demonstrated, unmoveable. The fact that an individual's views may be misconceived does not, however, deprive him of the right to hold them."

and at [45]

"When I told him of my decision and the fact that he would die, he told me without prompt or question that he did not want to. I formed the impression that he very much wanted to live. Ultimately, all I could do was tell him that the decision was his."

Read the judgment on Bailii