Court orders that patient can be restrained to undergo lifesaving dialysis against his wishes

A trust, which cannot be named for legal reasons, has applied to the Court of Protection for permission to restrain a patient in order to perform life saving dialysis.

The patient, identified only as Mr S, had expressed that while he did not wish to die, he did not think his condition was serious enough to require dialysis. The medical staff treating him believed that without dialysis he would die in a matter of weeks; their application was supported by Mr S’s family.

Mr S lacks capacity to make decisions about the medical treatment he receives. Mrs Justice Parker granted permission for the trust’s clinical staff to restrain Mr S, during dialysis if he continues to refuse treatment. She is quoted as saying, “[n]obody is suggesting that the gentleman is restrained in a straight-jacket or anything like that, it has to be proportionate … he should be gently restrained by having a hand-held by each nurse so it is possible to put in a catheter.”

Mrs Justice Parker acknowledged that “[r]estraint may exacerbate the medical difficulties”. She further expanded that should Mr S become agitated and remove lines from the dialysis machine during treatment, a potentially fatal embolism could be triggered. Additionally, a serious heart condition also means the stress could kill him.

Nevertheless, Mrs Justice Parker concluded that it would be in Mr S’s best interests to implement the weekly invasive treatment which “has a capacity to be cruel to him” in order to save his life.

This judgment is interesting not only because of its uniqueness, but because “gently” restraining someone raises very practical issues of difficulty in implementation. In Mr S’s case he has since submitted to the treatment (ie, restraint is not required) and the order has been extended indefinitely.

Unfortunately, as the case was settled by consent, there is no official judgment available for more scrutiny. What the reporting of the case shows is that, where it is felt to be in the best interests of a patient to receive dialysis against their wishes, it is possible to obtain permission to restrain a patient who lacks capacity to make decisions regarding medical treatment in order to administer life saving treatment but these will, of course, be dependent on the facts of the particular case.