A High Court judge has ruled that a mentally ill man with diabetes should not be forced to undergo a life-saving amputation by an NHS trust.

The judgment means the 73-year-old man, known as Mr B, is expected to deteriorate and die in coming days at a hospital run by the Wye Valley Trust in Herefordshire.

Royal Courts of Justice

The court accepted Mr B did not have capacity to make treatment decisions about his own care

The court heard that Mr B had complications from type 2 diabetes and suffered from paranoid schizophrenia, including hearing voices. He has a severe infection in his foot and leg that has spread to the bone and needs to be amputated.

Mr B, represented at the Court of Protection in London by David Lock QC, has refused to consent to the operation claiming the voices he can hear have told him not to. He has refused all treatment beyond the changing of his dressings.

The court accepted Mr B did not have capacity to make treatment decisions about his own care. The trust’s barrister argued the court should give greater weight in favour of the presumption of life.

But in the judgment published today, Judge Peter Jackson, who met Mr B in person, rejected the trust’s application. He said: “I am quite sure that it would not be in Mr B’s best interests to take away his little remaining independence and dignity in order to replace it with a future for which he understandably has no appetite and which could only be achieved after a traumatic and uncertain struggle that he and no one else would have to endure.

“There is a difference between fighting on someone’s behalf and just fighting them. Enforcing treatment in this case would surely be the latter.” 

He added: “A conclusion that a person lacks decision making capacity is not an ‘off switch’ for his rights and freedoms.  To state the obvious, the wishes and feelings, beliefs and values of people with a mental disability are as important to them as they are to anyone else, and may even be more important.  It would therefore be wrong in principle to apply any automatic discount to their point of view.”

The judge continued: “In some cases, of which this is an example, the wishes and feelings, beliefs and values of a person with a mental illness can be of such long standing that they are an inextricable part of the person that he is. In this situation, I do not find it helpful to see the person as if he were a person in good health who has been afflicted by illness.  It is more real and more respectful to recognise him for who he is: a person with his own intrinsic beliefs and values.

“It is no more meaningful to think of Mr B without his illnesses and idiosyncratic beliefs than it is to speak of an unmusical Mozart.”

The judge said that Mr B had shown “fortitude” in the face of death and earned the respect of those nursing him.

He added that Mr B had endured a “hard life” and despite being sociable had no next of kin and suffered repeated losses.