10 December 2015
Making For The Exit
The decision by a 50 year old woman to refuse treatment jars modern sensibilities
By John Watson
This week’s doings in the Court of Protection have raised a few eyebrows. A lady aged fifty, who had until then lived a hedonistic life, decided that she did not want to live on to be old, ugly, poor and without the sparkle she believed she had lost. Accordingly she attempted suicide, washing down the pills with Veuve Cliquot. It didn’t work but the combination did serious damage to her kidneys, damage which, in the view of the doctors, could be dealt with through dialysis offering a good prospect of complete recovery. She refused the dialysis, saying that she was determined to die anyway, and Kings College Hospital argued that she did not have the mental capacity to refuse the treatment which was clearly, by most normal criteria, in her best interests.
From a legal point of view the question was fairly straightforward. Under English law you do not have to accept treatment if you are of sound mind so the only question was whether she had the mental capacity to make the decision or not. After lengthy evidence, Mr Justice MacDonald decided that she had. The hospital was not allowed to impose the treatment and she died. There isn’t much new here for the lawyers.
What jars a little is the nature of her decision. We are used, these days, to a good deal of emphasis on the need to preserve life, even where that life has become fairly meaningless in practical terms. It is as if death, the final enemy, had to be kept waiting at the gateway as long as possible and there is little acceptance that it is merely the inevitable end of a journey. It wasn’t always that like that, of course, and there are plenty of examples in history of people who have held their lives very cheap. An extreme case was an incident which has been attributed to Simon de Montford (not the parliamentary one, but his father who commanded the Albigensian Crusade). According to the story the incident occurred when, during a siege, he saw one of his heavily armed knights fall into the moat. He threw off his armour and went in to pull him out under the bows of the defenders. So brave was his action that they did not fire and, afterwards, one of his colleagues came up to congratulate him on his courage. De Montford is said to have replied that he had taken no risk at all. He was on Crusade and, had he died, would have gone directly to heaven.
No doubt it was easier to accept death in the days of faith when it was not regarded as being the end. Still, the modern approach of always seeking to defer it seems to be built around fear and, when someone rejects it, it is worth looking at their reasons.
The lady who was the subject of the Court of Protection hearing knew a particular life, full of sparkle, money and men. Now she was in debt and, had she continued to live, her life would have been of a type which held no attraction for her. Why then, she must have asked herself, should she turn up for the event?
To a card player this reason would seem strange because the art of playing cards is not to be given a good hand but to play all hands, good and ill, with the maximum of ability and verve. Her decision was to play the good hand but not the bad and to treat the opportunity to play the latter as entirely valueless. It is odd too as a matter of values. Although the woman has not been identified, we know that she had children and a grandchild. Presumably she regarded the pleasure of watching them grow up as being worth little while her ability to star at fashionable parties counted for everything.
It is a strange set of priorities and that, no doubt, is what prompted the hospital to argue that she had no capacity, but that is an approach with obvious dangers. If making a decision in a particular way indicates that you do not have the capacity to make it in the first place, freedom of choice begins to disappear. Anyway, the case was not approached in that way but on the evidence, so no new law has been established. Still, however you look at it, it is a very sad case.
