When deciding what is in the best interests of a patient who lacks capacity to make decisions about their care, the courts will take into account any wishes and feelings expressed by the patient as well as the medical evidence. Recently, the Court of Protection ruled that a man with dementia who was being treated in hospital should continue to receive clinically assisted nutrition and hydration (CANH).

The 73-year-old man had been diagnosed with mixed Alzheimer's and vascular dementia in 2019. He had a number of other health conditions and had subsequently suffered a stroke. He had been cared for in hospital since October 2024 and had a nasogastric tube inserted as he could not safely swallow food and fluids. The NHS trust responsible for his care applied to the Court for a declaration that it was not in his best interests to continue to receive CANH. His eldest daughter, supported by his wife and his other children, opposed the application.

A consultant involved in the man's care gave evidence that he could look around and make eye contact but did not speak. While continuing CANH would prolong his life, allowing him to interact with his family, it would come with several burdens. Palliative care might make him more comfortable, would allow him to leave hospital to go home, and would make it more likely that his family would be present when he died.

His eldest daughter said that he would smile when his family visited him and when he was shown videos of his grandchildren. She felt he had a level of understanding of what his family discussed with him. He was a man of devout faith and had previously said that only God decided when someone would die. His wife, his son and his other daughter gave similar evidence.

The Court considered that the man would wish the enjoyment he received from being with his family to continue rather than be cut short to the 1-3 weeks he would have left if CANH were withdrawn. The Court unhesitatingly agreed with the family's evidence of his past wishes in respect of continuing treatment even where pain and disability are present, and found that there was a significant benefit to him living and dying in accordance with his faith. The Court also factored in that he was aware of his surroundings and environment, smiling and responding when his football team was mentioned. While his condition was unlikely to improve, it did not follow that his treatment was futile.

The Court noted that, while many patients would rather quickly and quietly slip away from a life of artificial hydration and nutrition when bed bound, its assessment of best interests was based on the perspective of the particular patient. The Court concluded that it was in the man's best interests to continue to receive CANH.