A 50-year-old woman who fears that the passing of her youth and beauty means the end of everything that “sparkles” in life has been granted permission to die by the court of protection.

In a highly unusual judgment published this week, King’s College Hospital NHS Trust has been told that the unnamed woman has the capacity to make up her own mind and is entitled to refuse the life-saving kidney dialysis treatment she requires.

The decision includes a detailed account of the lifestyle of C, as the woman is known, describing her as “impulsive”, “self-centred”, heavy drinking and four times married.

But the judge, Mr Justice MacDonald, explained that the principle was the same for any patient. “The right to refuse treatment extends to declining treatment that would, if administered, save the life of the patient,” he said in his court of protection decision.

“This position reflects the value that society places on personal autonomy in matters of medical treatment and the very long established right of the patient to choose to accept or refuse medical treatment from his or her doctor.

“Where a patient refuses life-saving medical treatment the court is only entitled to intervene in circumstances where the court is satisfied that the patient does not have the mental capacity to decide whether or not to accept or refuse such treatment.” Intervention, he said, was not required in this case.

MacDonald continued: “C is a person to whom the epithet ‘conventional’ will never be applied … C has led a life characterised by impulsive and self-centred decision-making without guilt or regret. [She] has had four marriages and a number of affairs and has, it is said, spent the money of her husbands and lovers recklessly before moving on when things got difficult or the money ran out.

“She has, by their account, been an entirely reluctant and at times completely indifferent mother to her three caring daughters. Her consumption of alcohol has been excessive and, at times, out of control … In particular, it is clear that during her life C has placed a significant premium on youth and beauty and on living a life that, in C’s words, ‘sparkles’.”

Having been diagnosed with breast cancer, she had taken an overdose with alcohol. She did not die but caused herself such extensive kidney damage that she required dialysis – which she now refused to undergo.

The judge added: “My decision that C has capacity to decide whether or not to accept dialysis does not, and should not prevent her treating doctors from continuing to seek to engage with C in an effort to persuade her of the benefits of receiving life-saving treatment in accordance with their duty to C as their patient.

“My decision does no more than confirm that in law C is entitled to refuse the treatment offered to her for her benefit by her dedicated treating team. Nothing I have said prevents them from continuing to offer that treatment.”

MacDonald analysed evidence from psychiatrists and medics, and from one of the woman’s daughters. One daughter told him that her mother’s life had “to all appearances” been fairly glamorous. She said her mother did not want to be “poor”, “ugly” or “old”.

“She has said the most important thing for her is her sparkly lifestyle,” said the daughter. “She kept saying she doesn’t want to live without her sparkle and she thinks she has lost her sparkle.”



The daughter said family members would devastated if her mother died, but added: “We think it is a horrible decision. We don’t like the decision at all. But I cannot get away from the fact that she understands it.”

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here