The High Court has refused consent for a 75-year-old man’s right leg to be amputated and instead approved a plan for him to return home with his family and receive palliative care when clinically appropriate.
In a judgment delivered on 13 June 2023, President of the High Court Mr Justice David Barniville said the man, identified as C.F. and Mr F. in the judgment, lacked capacity to decide whether to undergo the operation. The case was heard under the court’s wardship jurisdiction, which the judge said continued to apply to the proceedings.
The man had dementia and severe peripheral vascular disease. An infected, exposed graft in his right leg left him at imminent risk of a fatal haemorrhage and sepsis. His treating vascular surgeon argued for an above-knee amputation to address those dangers. A second vascular surgeon supported amputation from a surgical perspective. The treating surgeon also estimated a 50% chance of death within 30 days of the operation.
A geriatrician and a psychiatrist opposed amputation, citing its risks and the likely loss of mobility and severe psychological distress. The man had repeatedly and emphatically said he did not want his leg removed. The judge gave those wishes significant weight despite his lack of capacity.
The judge also considered evidence from a palliative care consultant about managing pain and other symptoms, planning for a possible major bleed, and supporting a discharge home. After the family met the palliative care team, they changed their position and supported bringing him home without surgery. The HSE and his guardian ad litem also supported that plan by the end of the hearing.
The judgment says a life-threatening bleed could not be reversed and might lead to death quickly. The court nevertheless concluded that the risks and consequences of amputation outweighed its potential benefits in this case, and that the presumption in favour of life-prolonging treatment had been rebutted.
The court refused consent to amputation and consented to the alternative plan: discharge home when clinically appropriate, with care from his family, the palliative care team, his GP and other support professionals. The order did not direct an immediate discharge; it made discharge dependent on clinical appropriateness and the care arrangements being put in place.