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Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67 - 30/10/13


Appeal concerning a declaration made under s. 15, Mental Capacity Act 2005 raising the issue of the correct approach to an assessment of whether it is in the best interests of a patient who lacks capacity to receive life-sustaining treatment.

Appeal dismissed. Held: The fundamental question is whether it is in the patient's best interests, and therefore lawful, to give the treatment, rather than whether it is lawful to withhold or withdraw it. If the treatment is not in their best interests, the court will not be able to give its consent on their behalf and it will follow that to withhold or withdraw it will be lawful.

There is a strong, although not absolute, presumption that it is in a person's best interests to stay alive. Best interests requires decision-makers to look at the welfare of a particular patient, at a particular time, in the widest sense and from the patient's point of view. Relevant considerations include medical, social and psychological welfare, the nature of the medical treatment in question, what it involves, its prospects of success and the likely outcome off treatment. They must consult others who are looking after the patient or are interested in their welfare, in particular for their view of what the patient's attitude would be.

In the present case, the trial judge was correct to consider whether the proposed treatments would be futile in the sense of being ineffective or being of no benefit to the patient. Although the Court of Appeal reached the right result, it set too high a standard and erred in its finding that the test of a patient's wishes and feelings is objective.