Why a woman who lost her 'sparkle' was allowed to die

By Clive Coleman
Legal correspondent, BBC News

  • Published
Media caption,

Clive Coleman explains the "right to refuse" treatment

A judge has ruled a 50-year-old "socialite" known only as C, who tried to kill herself, can refuse kidney dialysis treatment and so end her life because she feels she has lost her "sparkle".

Why has this case received so much attention?

Because of the extraordinary C.

Her life had revolved around "her looks, men, material possessions and living the high life", the judgement said.

She had had four marriages and several affairs and "spent the money of her husbands and lovers recklessly before moving on when things got difficult or the money ran out".

Last year, C had been diagnosed with breast cancer, but had refused treatment that would "make her fat".

A long-term relationship had broken down, she had been plunged into debt, and she had tried to kill herself by washing down paracetamol tablets with Veuve Clicquot champagne.

She had later told her daughters - by whom, despite her quirks, she was held "dear" - she had "royally cocked it up", the court heard.

The suicide attempt had badly damaged her liver - but with dialysis, her prognosis would be positive.

In a statement, C's daughter told the court: "Put bluntly, her life has always revolved around her looks, men and material possessions.

"She understands that other people have failed relationships, feel sad and continue living, but for her, as she has said, she doesn't want to 'live in a council flat', 'be poor' or 'be ugly', which she equates with being old."

Is this case about assisted suicide?

Absolutely not. Assisting a suicide is a criminal offence that carries a maximum prison sentence of 14 years.

This case is about the right of every individual who has mental capacity to refuse medical treatment.

Sitting in the Court of Protection, which makes decisions on behalf of those who lack mental capacity, Mr Justice MacDonald quoted a statement of the law from an earlier case, which could not be clearer.

"An adult patient who… suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered," it said.

"This right of choice is not limited to decisions which others might regard as sensible.

"It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent."

So, for example, a Jehovah's Witness who has mental capacity can refuse a life-saving blood transfusion.

So what was the issue in the case?

King's College Hospital, in south London, had applied for a ruling from the Court of Protection that C lacked the mental capacity to make decisions about the dialysis treatment.

The hospital wanted to be able to treat her against her expressed wishes.

The judge considered the evidence from three psychiatrists, one of whom concluded C was not able to use and weigh up information about her condition and future due to an "underlying diagnosis of histrionic personality disorder and her current circumstances".

Critically, he also heard from C's daughters.

In a statement, one said: "'Recovery' to her does not just relate to her kidney function, but to regaining her 'sparkle' (her expensive, material and looks-oriented social life), which she believes she is too old to regain."

Having considered all of the evidence, the judge decided C did have mental capacity to refuse dialysis treatment.

Does this case change the law?

Not at all. The facts may be extraordinary, but the law is clear and unchanged by them.

However, C's case reminds us of the right each person has to refuse medical treatment so long as they have mental capacity.