Northern Ireland

High Court rules doctors can carry out amputation in case of brain-damaged patient without his consent to prevent further infection spread

High Court in Belfast
High Court in Belfast

Doctors can partially amputate the leg of a brain-damaged patient lacking capacity to give his informed consent, the High Court has ruled.

A judge granted permission for the operation on Monday after being told the diabetic man could die if a foot infection spreads to the rest of his body.

Mr Justice Simpson ruled: “I am satisfied from the medical evidence that the proposed treatment is both necessary and in the best interests of the patient.”

Urgent proceedings were brought by Belfast Health and Social Care Trust seeking a declaration that amputation below the knee can lawfully be carried out.

The patient, whose name and age were not disclosed, has type 1 diabetes and was admitted to hospital earlier in August with an ulcer on his heel.

Medical staff later discussed the possibility of amputation, but concluded that he lacked capacity to make a decision.

With a history of heavy alcohol use, he previously suffered a traumatic brain injury while intoxicated which has affected his mobility and cognitive functions.

Earlier this month a consultant surgeon stated it was necessary to remove the man’s foot to prevent further spreading of infection “which can lead to overwhelming sepsis and death”.

Despite the risk of undergoing surgery associated with his medical history, the benefits were assessed as far outweighing the alternative of doing nothing.

A consultant psychiatrist with the Trust provided a report which set out concerns about his worsening cognitive impairment.

Citing the patient’s brain injury and alcohol-related brain damage, she concluded that he was unable to demonstrate adequate understanding of the planned amputation.

The court also heard that the man’s family supported the procedure being carried out and have made efforts to obtain suitable accommodation for him after he leaves hospital.   

In his published judgment, Mr Justice Simpson said: “I am satisfied that the patient lacks capacity to make an informed decision about the proposed treatment.”

Acknowledging the patient’s privacy rights, the judge held that the surgical procedure is a proportionate response to his medical problems. 

He confirmed: Accordingly, I grant the declaratory relief sought and I approve the draft order.”