Judge Backs Treatment for Girl With Diabetes Who Wanted to Die

Peter Russell

July 05, 2019

A High Court judge gave doctors permission to administer insulin to a teenage girl with type 1 diabetes who had refused treatment and had expressed a wish to die.

Mr Justice Macdonald said that there was no evidence that the girl, named only as 'B', lacked mental capacity but that it was in her best interests to receive treatment proposed by her medical team.

The application was brought by the University Hospitals Plymouth NHS Trust which had responsibility for the medical care and treatment of the teenager.

Diabetic Ketoacidosis

The judge outlined details of the case in a ruling published online. He said that B, who had insulin dependent diabetes mellitus, had refused to administer insulin for several days prior to admission to hospital despite requests to do so.

Initial hospital tests found a markedly elevated blood sugar level of more than 38 and a ketone level of 2.5.  Later blood testing demonstrated a blood sugar level of 27.8, a ketone level of 5.5, and a blood pH of 7.19 (acidosis).

Medical staff noted that B appeared confused, and vomited, and that her failure to receive insulin resulted in her developing diabetic ketoacidosis (DKA). As a result, B was admitted to the High Dependency Unit.

Urgent Decision 'Justified'

In a report, two doctors stated that without treatment for her DKA the teenager's condition would deteriorate to the point of cerebral oedema and death. In addition, she was at risk of cardiac arrhythmias secondary to abnormal potassium levels and, in severe cases of dehydration, renal failure.

Mr Justice Macdonald said that despite a lack of psychiatric evidence for the specific case, the court was aware "that children who have to live with the unenviable burden of chronic medical conditions sometimes seek, particularly during their teenage years, to deal with the unremitting pressure of such a situation by seeking to exercise control of the seemingly uncontrollable in the only way available to them, namely by refusing to co-operate with their treatment".

Finding in favour of the hospital trust's application, he ruled that an urgent decision was justified in light of the narrow window for treatment.

Mr Justice Macdonald said that he had borne in mind B's stated wishes but that "the court is not mandated to accept the wishes and feelings of a competent child where to honour those wishes and feelings would result in manifest, and even fatal, harm to that child".


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