The kerrie wooltorton inquest

Facts

Kerrie Wooltorton died on the 19th September 2007, from ethylene glycol toxicity. She was admitted to hospital where it was discovered she had swallowed 350 millilitres of antifreeze. She stated that she did not require any medical intervention except to keep her comfortable. She was also in possession of a letter written by her and dated 14 September 2007.

To whom this may concern, if I come into hospital regarding taking an overdose or any attempt of my life, I would like for NO lifesaving treatment to be given. I would appreciate if you could continue to give medicines to help relieve my discomfort, painkillers, oxygen etc. I would hope these wishes will be carried out without loads of questioning.

Please be assured that I am 100% aware of the consequences of this and the probable outcome of drinking anti-freeze, e.g. death in 95-99% of cases and if I survive then kidney failure, I understand and accept them and will take 100% responsibility for this decision.

I am aware that you may think that because I call the ambulance I therefore want treatment. THIS IS NOT THE CASE! I do however want to be comfortable as nobody want to die alone and scared and without going into details there are loads of reasons I do not want to die at home which I realise that you will not understand and I apologise for this.

Please understand that I definitely don't want any form of Ventilation, resuscitation or dialysis, these are my wishes, please respect and carry them out.

Yours sincerely

Kerrie Wooltorton

Letter by Kerrie Wooltorton, Notes of Extracts from summing up by Coroner William Armstrong, HM Coroner - Great Norfolk District, Kerrie Wooltorton Inquest (2009)

When questioned by doctors she referred them to the letter making it clear she was aware of the life threatening risks involved and was no consenting to life saving treatment. Over a period of time Wooltorton insisted that she not have any medical intervention and continued to refuse treatment.

The attending physician Dr. Heaton when confronted with this situation consulted with the nurses, a Dr. Southgate via telephone, he also took advice from the Medical Director and legal advice. Dr. Heaton was of the view that Kerrie Wooltorton had capacity and therefore had the right to refuse treatment. As a result of this refusal Wooltorton was pronounced dead on the 19th September 2007.

Legal Issue

The Coroner William Armstrong in determining the cause of death, sought to address the mental capacity of the deceased Kerrie Wooltorton to refuse treatment. In addressing this issue Sections 1, 2 and 3 of the Mental Capacity Act (2005) were examined.

1 The principles

(1) The following principles apply for the purposes of this Act.

(2) A person must be assumed to have capacity unless it is established that he lacks capacity.

(3) A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

(4) A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

(5) An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

(6) Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

Section 1 of the of the Mental Capacity Act (2005)

Coroner William Armstrong's summation of evidence, addressing the legal issue:

....there is guidance from the General Medical Council and guidance from the Department of Health and there is of course internal guidance from the hospital which reaffirms the principles of the Act and sets out how professionals should deal with these issues. Dr HEATON decided that, as I've already said, Kerrie had capacity and she could not therefore be treated and indeed, going further than that, if she was treated in those circumstances, and her wishes overridden, it would have been an assault to have done so. . . the fact that a deliberate decision to die may be regarded as perverse or repugnant does not mean that anyone has the right to overrule the decision when that decision is made by an adult with capacity. Any treatment to save Kerrie's life in these circumstances would have been unlawful because the law respects the autonomy of an individual to make a decision even if the decision is seen to be perverse or unwise by others.

Notes of Extracts from summing up by Coroner William Armstrong, HM Coroner - Great Norfolk District, Kerrie Wooltorton Inquest (2009)

Verdict

In this inquest Coroner William Armstrong pronounced the following:

“Kerrie anne wooltorton died as the result of deliberately consuming a poisonous substance in the full knowledge that death could result. She had capacity to consent to treatment which, it is more likely than not, would have prevented her death. She refused such treatment in full knowledge of the consequences and died as a result”

Notes of Extracts from summing up by Coroner William Armstrong, HM Coroner - Great Norfolk District, Kerrie Wooltorton Inquest (2009)

This inquest is similar in nature to The Case of St George Health Care N.H.S. Trust v S (1999) where the capacity and autonomy of the individual was addressed in refusal to have medical treatment.

It was held on appeal that “even when his or her life depended on receiving medical treatment, an adult of sound mind was entitled was entitled to refuse it;” The removal of the baby without her consent “constituted an infringement of her autonomy and amounted to a trespass,”

This verdict reaffirms the existing case law on trespass to person and the autonomy of the individual.

References:

Notes of Extracts from summing up by Coroner William Armstrong,

HM Coroner - Great Norfolk District, Kerrie Wooltorton Inquest (2009)

Sections 1, 2 and 3 of the Mental Capacity Act (2005)

St George Health Care N.H.S. Trust v S (1999)