Is ‘life’s not much fun any more’ good enough reason to refuse treatment?
Is “life is no fun any more” sufficient and rational reason to refuse life-saving medical treatment? A British judge in the Court of Protection decided that it was in the case of “C”, a woman dying of kidney failure.
The woman behind the judgement in Kings College Hospital NHS Foundation Trust v C & Anor is – or was (she may be dead by now)– an extraordinary character. Here is Justice MacDonald’s summation of her life
C is a person to whom the epithet ‘conventional’ will never be applied. By her own account, the account of her eldest daughters and the account of her father, C has led a life characterised by impulsive and self-centred decision making without guilt or regret. C has had four marriages and a number of affairs and has, it is said, spent the money of her husbands and lovers recklessly before moving on when things got difficult or the money ran out. She has, by their account, been an entirely reluctant and at times completely indifferent mother to her three caring daughters. Her consumption of alcohol has been excessive and, at times, out of control. C is, as all who know her and C herself appears to agree, a person who seeks to live life entirely, and unapologetically on her own terms; that life revolving largely around her looks, men, material possessions and ‘living the high life’. In particular, it is clear that during her life C has placed a significant premium on youth and beauty and on living a life that, in C’s words, ‘sparkles’.
With respect to youth and beauty, her daughter V states that just as C has never seen herself as a mother, she has never seen herself getting old. Upon being diagnosed with breast cancer in December 2014 when aged forty-nine V relates that C expressed the view that she was “actually kind of glad because the timing was right”. It is recorded in C’s medical notes that she did not want to discuss the benefits and risks associated with chemotherapy but was “keen not to have any change in size or deficit that will affect her wearing a bikini”. She refused to take medication prescribed for the disease because “it made her fat”.
C’s socialite life fell apart within a few months. In December last year she was diagnosed with breast cancer, she had treatment, her latest relationship failed, she lost her home, she was buried under debt, and she was arrested and faced criminal charges over an apparently minor matter.
So on September 7, C went to the beach and washed down 60 paracetamol tablets with a bottle of Veuve Clicquot. But (to use her own words) she “royally cocked it up” and ended up in King’s College Hospital instead of the morgue, suffering from a damaged liver and kidney failure.
Her doctors were cautiously optimistic about her prognosis, but she would have to be on a dialysis machine for many months. C, however, wanted to refuse all treatment, fully aware that she would die without it. The hospital applied to the court for authorisation to restrain C to allow her to be treated; her family supported her decision. Two psychiatrists believed that C could not be of sound mind because she refused to believe that she would recover. Her pessimism about the future was irrational.
So the question before the court was essentially whether her apparently frivolous reasons for wanting her life to end were rational and “capacitous”.
Having heard the evidence, the judge decided in favour of C and ordered the hospital to respect her wishes. To him, her decision seemed unwise; to others it might seem “unreasonable, illogical or even immoral within the context of the sanctity accorded to life by society in general”. But her decision to effectively commit suicide was a rational within her own ethical universe:
“C is entitled to make her own decision on that question based on the things that are important to her, in keeping with her own personality and system of values and without conforming to society’s expectation of what constitutes the ‘normal’ decision in this situation (if such a thing exists). As a capacitous individual C is, in respect of her own body and mind, sovereign.”
refusal of treatment
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