Judge rules doctors should treat teen with type 1 diabetes who wants to die

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A High Court judge has ruled that doctors can treat a teenager with type 1 diabetes, despite her refusing treatment. The girl - who cannot be named for legal reasons - has consistently rejected insulin, telling her healthcare team in Plymouth that she wanted to die. Doctors from University Hospitals Plymouth NHS Trust went to court as the teenager’s life depended on receiving urgent treatment for her condition. Judge Mr Justice MacDonald heard the case and said he found no evidence to suggest the teenager lacked any mental capacity. Regardless, he has ruled that, under the circumstances, the right thing to do was to override her wishes. According to the National Institute for Health and Care Excellence (NICE), people who are diagnosed with a chronic health problem are three times more likely to develop depression. Depression is the most common psychiatric disorder experienced by the diabetes community. It can impact how people manage their condition and can sometimes lead to diabetes burnout. Being diagnosed with type 1 diabetes can be upsetting for some people as they struggle to adjust to managing a chronic condition. However, there is support available and millions of people with type 1 diabetes do manage to live a happy and healthy life once they have come to terms with it. Many people find the Diabetes Forum helpful for learning about and coming to terms with diabetes.

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My heart goes out to the young woman and her family, she has clearly hit rock bottom :(
 
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kitedoc

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These situations are harrowing.
It is interesting that no mental incapacity was found in this diabetic teenager.
It takes a higher degree of mental capacity to reject a life-saving and life-maintaining therapy than to accept it.
I can only assume it was a psychiatrist's opinion.
I also wonder what would have happened if she had been older than 18 years of age. ( just guessing her age here)
In any case another distressing situation for all concerned.

Edited by a moderator to remove comments detracting from the original post.
 
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bgst

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This is nuts. In a different thread, Clare expressed:

"Not long after I was diagnosed at the age of 15 I refused to take my injections a number of times. My brother's used to sit on me while my mum injected me in the bottom or leg. I'm glad they did. I am soon to be 51, have a wonderful life with my husband and yes it's hard being diabetic and sometimes it makes me cry and I feel sorry for myself but I always remember there are people with worse things than me. Hopefully this young girl will grow up and appreciate what was done for her."

I agree with her - I developed diabetes in South Africa where the care is nowhere near as good as in the UK. For anyone in the UK that thinks that death is the best answer, could I suggest that you go and visit a 3rd world country where people get half the support we get in the UK to see what life could be like? For some reason they appear to be far happier with far less.

Diabetes can be controlled, and many diabetics live a fulfilling life. Some even become Prime Minister of first world countries. Out current Prime Minister (yes, I know she has resigned, but don't let that take away from her awesome achievements) is an example of this. If your medical team are letting you think that Diabetes will hold you back, perhaps you should get a second opinion from another doctor / diabetic specialist?

My personal opinion: Diabetes is a condition that can be managed - it is not a death sentence. Take control. Own it. Choose what you want to do. Get out and do it. Don't let Diabetes be an excuse.
 
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kitedoc

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Interesting that no psychiatrist opinion was sought regarding assessing this person's decision-making capacity.
And I could not see where either of the two paediatricians stated they had examined the patient and found her to possess requisite competency to refuse life-saving treatment, not just on admission but also later on in her admission.
Yet it seems to me that such competency has been assumed by the court.
Also no order is evident regarding the patient's future requirements for other than diabetes management per se (such as psychiatric/psychological assessment and management to perhaps prevent recurrences of her dangerous medical condition of DKA).
 

Brunneria

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Hi @kitedoc,

I think that if you read the link Scott provided, you will find your queries answered at points 1, 9, 16 and 19.

The document covers an emergency situation, so I wouldn't expect it (or the judge) to step beyond that and tackle wider issues at this stage. Though I am quite sure that those wider issues will be addressed by the patient's health team.
 
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kitedoc

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Thank you @Brunneria.
Without psychiatric report/assessment it is unclear to me whether the patient had requisite capacity to refuse treatment and to fully appreciate her situation (if say in a state of suicidal depression ) if that were the case. And the paediatricians may not have felt skilled enough to have made that assessment.
I wonder how many people feel like dying during evolving stages of DKA anyway??
In any case as you say it was because of the the imminent emergency that the court case was convened and one is glad that her life has been preserved.
 

TJR56

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I recently was at a hospital fete, 'man'ning a stall with others of our local Diabetes Patients Supporters group, and a young woman in hospital gown with drip on a mobile stand came to talk, with her partner. She was recovering from a DKA and wanted first of all to ask if either of us had children - no, as it happens - and if she could have children with diabetes. Though we cannot give clinical advice we were glad to assure her from personal experience of friends on this point and offer her relevant sources of advice. She mainly wanted to know whether it is possible to have a 'normal' and happy life with the condition and our overwhelming answer was 'yes', but it's a hell of a lot better if you learn the game, live by the rules. She went away saying she would take on board 'this time' what advice she was given.

As a rebellious teenager I tried to ignore my diabetes for a while, and it took a 'wake-up' emergency admission to hospital for me to start to be willing to learn about my condition and manage it but I am so glad I did. Yes, it's a lifelong job but you have the best chance of extending both quality and span of life if you 'play the game' and get to be good at it. This is my message to anyone in despair or despondency. It's worth it. You're worth it.
 
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I recently was at a hospital fete, 'man'ning a stall with others of our local Diabetes Patients Supporters group, and a young woman in hospital gown with drip on a mobile stand came to talk, with her partner. She was recovering from a DKA and wanted first of all to ask if either of us had children - no, as it happens - and if she could have children with diabetes. Though we cannot give clinical advice we were glad to assure her from personal experience of friends on this point and offer her relevant sources of advice. She mainly wanted to know whether it is possible to have a 'normal' and happy life with the condition and our overwhelming answer was 'yes', but it's a hell of a lot better if you learn the game, live by the rules. She went away saying she would take on board 'this time' what advice she was given.

As a rebellious teenager I tried to ignore my diabetes for a while, and it took a 'wake-up' emergency admission to hospital for me to start to be willing to learn about my condition and manage it but I am so glad I did. Yes, it's a lifelong job but you have the best chance of extending both quality and span of life if you 'play the game' and get to be good at it. This is my message to anyone in despair or despondency. It's worth it. You're worth it.

I loved reading your positive post, a huge thank you :)
 
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