In PW (Jehovah’s Witness: Validity of Advance Decision), Re [2021] EWCOP 52, Mrs W, aged 80, had Alzheimer’s. She was seriously ill in hospital with potentially fatal internal bleeding from a gastric tumour and the evidence was that a blood transfusion and surgery could mean that she would live for another five to ten years. However, she had been a practising Jehovah’s Witness for most of her adult life, [1]. Her medical team had concluded that she lacked capacity to make decisions about her treatment, but she had made an advance decision in 2001 – which appeared to have been held on a register of such decisions made by Jehovah’s Witnesses –  to refuse blood or blood products even if her life was in danger. All parties accepted that the advance decision had been properly made [3].

The question for the court was whether, if Mrs W lacked capacity to make a decision whether to consent to or refuse a blood transfusion, her advance decision in 2001 was valid within the meaning of the Mental Capacity Act 2005 [3].

In 2020, she had given her four children Lasting Power of Attorney (LPA), registered with the Office of the Public Guardian, to make decisions about her health and welfare on her behalf. She had not given them any specific instructions about treatment with blood transfusion or anything else, but she had elected not to authorise them to give or refuse consent to life-sustaining treatment on her behalf [5]. Further, she had expressed her agreement to having a blood transfusion and had then withdrawn it thirty minutes later [6], and when a “Do Not Resuscitate” (DNR) notice had been put in her medical records by mistake she had spoken to staff at the hospital to ensure that it was removed [10]. Continue reading →