It frequently falls to family judges to address the ghastly human consequences of the COVID-19 pandemic. That was certainly so in the case of a much-loved mother who was authoritatively described as the most complex COVID-19 patient in the world.
The impact of the virus on the woman, aged 56, followed an unfamiliar pattern. After developing a severe inflammatory response, she suffered extensive brain damage. She had for months been dependent on mechanical ventilation and tube feeding in a hospital’s intensive care unit (ICU). The team of doctors treating her were of the view that it would be in her best interests to discontinue active medical treatment.
One doctor spoke of the distress and loss of dignity and autonomy that her treatment inevitably involved. Her recall was minimal and, if her level of consciousness were to improve, it was possible that she might relive the traumatic discovery of her condition repeatedly. The doctor was concerned that she would be inconsolable and focus solely on thoughts of fear, anxiety and hopelessness.
On the other hand, the comfort she took from the presence and reassurance of her four children provided a shaft of sunlight into her otherwise parlous existence. There was evidence that she was able to answer short and focused questions, that she could give and respond to love and that she took solace in prayer. In the absence of a solution that was in any way comforting, her children, whilst trying to achieve unanimity, had vacillated as to the best way forward.
Ruling on the matter, the High Court noted that her life expectancy was certainly less than 12 months. She was dying slowly in both physical and emotional pain. Her treatment was burdensome and exhausting and her rest was by necessity frequently disturbed on a small, noisy mixed-gender ward. Her situation, however, presented a real opportunity to plan for a peaceful end to her life.
The Court found that, were she able to express her own wishes and feelings, she would not want to continue with her current treatment. Maintaining the status quo was not an option. All medical options had been pursued to the full and further treatment would be futile.
The NHS trust bearing responsibility for her care was given permission to cease mechanical ventilation and to move her out of the ICU to a quiet environment, possibly a hospice, where she could live out her final days in peace, privacy and the presence of her family. That, the Court found, was the course most likely to preserve her human dignity to the end of her life.