Mentally-ill pensioner 'should not face enforced amputation'

A diabetic, mentally-ill pensioner should not be forced to have his severely-infected left foot amputated even though he could die within days without surgery, a judge has ruled.

Mr Justice Peter Jackson has concluded that "enforced amputation" would not be in the 73-year-old man's best interests after analysing the case at a hearing in the Court of Protection, in London, where issues relating to sick and vulnerable people are considered.

The pensioner - who had suffered mental illness for decades, had no next of kin and was "isolated" - might live for a few years if his foot was amputated, the judge said.

He had opposed surgery in "the strongest possible terms" and said: "I'm not afraid of dying ... It would be a better life than this."

Mr Justice Jackson concluded that the pensioner did not have the mental capacity to make decisions about treatment.

But the judge said it would not be in the pensioner's best interests to "take away his little remaining independence and dignity" in order to replace it with a future for which he "understandably" had "no appetite".

The judge made his decision after visiting the unit where the man was being cared for and speaking to him for more than an hour.

Bosses at a health trust had asked the judge to allow doctors to amputate the pensioner's left leg below the knee against his will in order to save his life.

The pensioner's interests had been protected by a lawyer representing the Official Solicitor's office - an official body which gives legal help to vulnerable people - who supported the trust's plan.

Mr Justice Jackson was told that the pensioner had developed paranoid schizophrenia in his mid-20s and heard "voices of angels and of the Virgin Mary".

He had also suffered from diabetes for some years and last year had developed a chronic foot ulcer that had not healed despite doctors' efforts. Amputation had been discussed for about a year. His foot was "putrefying" but he was refusing all treatment - only allowing dressings to be changed. A specialist had said the pensioner could "succumb" within days to "overwhelming infection".

The judge said neither the pensioner nor the unit where he was being cared for could be identified.

But he said the trust which had asked for a declaration that amputation would be lawful could be named as the Wye Valley NHS Trust - which is based in Hereford.

He said the trust's application had been "rightly brought" - even though it was dismissed.

"The issue in this case is whether it is lawful for the doctors treating (the pensioner), a 73-year-old gentleman with a severely infected leg, to amputate his foot against his wishes in order to save his life," said Mr Justice Jackson, in a written ruling on the case.

"Without the operation, the inevitable outcome is that he will shortly die, quite possibly within a few days. If he has the operation, he may live for a few years.

"(The pensioner) has a long-standing mental illness that deprives him of the capacity to make the decision for himself. The operation can therefore only be lawfully performed if it is in his best interests."

The judge said when a patient lacked the mental capacity to make decisions, it was of "great importance" to give "proper weight" to their wishes and feelings.

And he said he had reached a "clear conclusion" that "enforced amputation would not be in (the pensioner's) best interests".

"(The pensioner) has had a hard life. Through no fault of his own, he has suffered in his mental health for half a century ... He has no next of kin. No-one has ever visited him in hospital and no-one ever will. Yet he is a proud man who sees no reasons to prefer the views of others to his own," said Mr Justice Jackson.

"I am quite sure that it would not be in (his) 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."

He went on: "There is a difference between fighting on someone's behalf and fighting them. Enforcing treatment in this case would surely be the latter.

"The application, which was rightly brought, is accordingly dismissed."

Barrister Vikram Sachdeva QC, who represented the trust, had accepted that performing an amputation against a person's wishes was "an extremely serious step to take".

But he had added: "However, where as here ... no other course will save (a patient's life) and avert his imminent death, it may still be in a (patient's) best interests."

And barrister David Lock QC, for the Official Solicitor, had told the judge that the Official Solicitor approved a plan put forward by the trust and thought that amputation would be in the pensioner's best interests.