Helen Mulholland appears for hospital Trust in serious treatment decision case concerning amputation in patient with complex physical and mental health needs

Mr Justice Cohen presided over the case of ZA, a 53 year old woman with complex physical and mental health issues.

The Hospital Trust applied to the Court of Protection for a decision on whether amputation was in ZA’s best interests. The clinicians were not unanimous in considering that amputation was indeed in her best interests; the family supported amputation, although they were concerned about the potential effect on ZA’s mental health of undergoing such surgery.

ZA refused amputation, but did not accept the advice of her doctors that without it she would die. She repeatedly said that her foot was fine and that it would recover (in fact, by the time of the hearing the foot was flail: there was no bony attachment of the foot at all and there was an open wound through which the tibia and fibula were visible).

The Judge noted that ZA was unable to understand death and that she either did not understand, or did not believe, the medical information she was given. He noted that ZA had always been consistent in refusing amputation, including on occasions when she was deemed to have capacity.

The medical evidence was that the foot would never recover and that, absent amputation, ZA would likely die within months (with amputation she might live for several years). From the point of view of her physical health, ZA’s infection could only be treated with amputation – no other treatment would be effective.

ZA’s situation was complicated by her mental health condition. The prognosis for her mental health in the absence of amputation was that her delirium would remain (since it was caused by the infection). The mental health prognosis in the presence of amputation was complex and uncertain.

The Judge considered that it was a difficult and finely balanced case, but concluded that amputation would not be in ZA’s best interests.

The judgment can be found here:







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