## Facts

- Ms B, a 43-year-old woman, became tetraplegic after a cervical spinal hemorrhage and was dependent on invasive mechanical ventilation.
- Before the second hemorrhage, she executed a “living will” expressing that she did not want artificial life-prolonging measures if she could not give instructions and her condition was seriously and irreversibly deteriorated.
- During intensive care, Ms B repeatedly and consistently requested withdrawal of ventilation, understanding it would likely lead to death within hours and requesting appropriate palliative measures.
- Clinicians initially treated Ms B as lacking capacity; the Trust obtained multiple psychiatric assessments, with opinions fluctuating, including concerns about depression.
- By around August 2001, Ms B was regarded as having capacity, and she continued to insist on withdrawal; she instructed solicitors to make a formal request to the Trust.
- The Trust declined to switch off ventilation as requested, proposing alternatives such as gradual “one-way weaning” or hospice transfer without guaranteeing withdrawal on request; Ms B rejected these options.
- Ms B brought proceedings in January 2002 seeking declarations of capacity and unlawfulness of continued treatment, nominal damages, and anonymity/reporting restrictions.

## Issues

1. Whether Ms B had decision-specific mental capacity to refuse artificial ventilation knowing refusal would likely cause death.
2. If Ms B had capacity, from what date she had that capacity (including whether she had it from about August 2001).
3. Whether continuing ventilation contrary to a competent refusal was unlawful and amounted to trespass to the person.
4. Whether declaratory relief and nominal damages were appropriate.
5. Whether anonymity and reporting restrictions should continue after judgment (including after Ms B’s death).

## Decision

- The court found Ms B had capacity to make decisions about her medical treatment, including refusal of ventilation, with competence commensurate with the gravity of the decision.
- The court declared that a competent adult has the right to refuse life-saving treatment even if death results.
- The court held that, once Ms B had capacity and clearly refused ventilation, continued ventilation without consent was unlawful and constituted trespass to the person.
- The court granted the requested declarations and awarded nominal damages.
- The court continued the reporting injunction protecting anonymity for Ms B, her family, the hospital, and staff, including after her death unless varied by the court.

## Legal Principles

- A competent adult patient has an absolute right to refuse medical treatment, including life-sustaining treatment, even where refusal will lead to death.
- Capacity is decision-specific and assessed functionally: the patient must be able to understand, retain, and use/weigh relevant information and communicate a decision; the level of capacity required is commensurate with the seriousness of the choice.
- A refusal is not invalid merely because clinicians regard it as unwise, because the patient was previously ambivalent, or because the patient has not experienced all proposed alternatives (e.g., rehabilitation) if she can understand and evaluate them.
- When a competent refusal is clear, continued invasive treatment without consent is unlawful and may sound in trespass to the person.
- If clinicians conscientiously object to implementing withdrawal, the provider must take reasonable steps to arrange transfer to a team or institution willing to carry out the lawful decision.

## Conclusion

The court affirmed that a mentally competent adult may refuse life-sustaining ventilation and that clinicians and hospitals must respect that refusal; once capacity and refusal were established, ongoing ventilation without consent was unlawful, justifying declaratory relief, nominal damages, and continued anonymity protections.


Ms B v. An NHS Hosp. Tr., [2002] EWHC 429 (Fam.) (Eng.)