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You are here: BAILII >> Databases >> England and Wales Court of Protection Decisions >> ZA, Re (Mental Capacity Act 2005) [2021] EWCOP 39 (30 April 2021) URL: https://www.bailii.org/ew/cases/EWCOP/2021/39.html Cite as: [2021] EWCOP 39 |
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COURT OF PROTECTION
IN THE MATTER OF THE MENTAL CAPACITY
ACT 2005
A N D
IN THE MATTER OF ZA
Strand London, WC2A 2LL |
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B e f o r e :
____________________
AN NHS FOUNDATION TRUST |
Applicant |
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- and - |
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ZA (by her litigation friend, the Official Solicitor) |
Respondent |
____________________
MS E. SUTTON appeared on behalf of the Respondent.
(via Microsoft Teams)
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Crown Copyright ©
MR JUSTICE COHEN:
The History.
"Inability to make decisions
(1) For the purposes of section 2, a person is unable to make a decision for himself if he is unable—
(a) to understand the information relevant to the decision,
(b) to retain that information,
(c) touse
or
weigh
that information as part of the process of making the decision, or
(d) to communicate his decision (whether by talking, using sign language or any other means).
ZA's Medical History.
The Views of the Doctors
(i) This lady would be best served, looking at the issue in a vacuum, by an above the knee amputation. It would remove the infected bone and flesh. The doctors are clear and unanimous that a below the knee amputation would be counterproductive because ZA will not be able to use
a prosthesis because of her cognitive impairment, and the result of a below the knee amputation would be to leave the knee muscles in a state of contraction which would cause pain and be likely to necessitate an above the knee operation. It would be of no benefit to ZA to leave her with a knee she cannot
use
.
(ii) If she does not have surgery, the probability is that she will die within six to 12 months from sepsis which will overwhelm her. On that Doctors A, B and Mr Scurr concur. If she does have the surgery Dr B and Mr Scurr agree that she will be likely to live for somewhere in the bracket of 5-10 years. Dr A, the one of the three of them who is not the vascular surgeon, promoted the idea that she would live for 20 years.
(iii) I agree with the evidence of the vascular surgeons. They explained convincingly why this lady's other problems will mean that her life expectancy is significantly diminished. Above all, those problems are the complications of her uncontrolled diabetes, and her non-compliance with medication. I was given statistics for the long term survival of those with diabetes, namely that after limb amputations only one-third remain living after three years. In addition, there is a strong likelihood of ulcers appearing at a fresh site, in particular the left leg, and the other complications of diabetes, as I have mentioned, will remain significant.
The Arguments in favour of Amputation
The Arguments against Amputation
Discussion