Re PW (Jehovah's Witness: Validity of Advance Decision) [2021] EWCOP 52

Judgment concerning whether an 80-year-old’s advance decision on receiving a blood transfusion was valid.

PW is an 80-year-old woman and a Jehovah’s Witness. Due to a gastric tumour, PW had suffered from internal bleeding which led to severe anaemia. A blood transfusion would allow a treatment method to be identified and would be likely to increase PW’s life for another five to ten years. Without a blood transfusion, PW was at risk of sudden death at any time. PW signed a proforma advance directive in 2001 in which she decided to refuse blood or blood products if her life was at risk. It has also been concluded by a Consultant Geriatrician that PW lacks capacity to make decisions regarding her treatment. The question for Poole J in this case was whether PW has the capacity to make a decision regarding the blood transfusion and, if so, whether the advance decision in question was valid under the Mental Capacity Act 2005 (MCA 2005).
 
Poole J accepted that PW lacked capacity to make a decision regarding the blood transfusion. PW had made a health and welfare lasting power of attorney (LPA) for her children in November 2020. When determining whether PW had done anything “inconsistent with the advance decision remaining her fixed decision” in accordance with section 25(2)(c) of the MCA 2005, however, Poole J held that the advance decision was not valid. The LPA made by PW, the fact that the removal of a DNR notice had been sought, and the wishes and feelings expressed by PW when she lacked capacity which did not align with the decision, were sufficient to show that PW had done something which was “clearly inconsistent with the advance decision”. Poole J concluded that it would be in PW’s best wishes to have a blood transfusion.

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