Relatives of a 20-year-old roofer who suffered a brain injury after becoming involved in a fight in a pub garden have failed to persuade a High Court judge that life-support treatment should continue.
Mr Justice MacDonald ruled that doctors can lawfully stop treating Andy Casey, of Mitcham, south-west London.
Specialists say Mr Casey’s brain-stem function has died and he is therefore dead.
This is a tragic matter whereby the trust seeks a declaration that very sadly Andy's brain-stem function has died and that thereby he has died— Abid Mahmood
Mr Justice MacDonald, who considered evidence at a private hearing in the Family Division of the High Court, in the Royal Courts of Justice complex in London on Friday, said he agreed.
Hospital trust bosses responsible for Mr Casey’s care had asked the judge to rule that treatment could lawfully end.
Relatives wanted treatment to continue, saying they had seen movement and signs of life.
Mr Casey’s sister, Christine Casey, told the judge she did not believe that he was brain-stem dead.
She said after the ruling: “I am so angry.”
A lawyer representing St George’s University Hospitals NHS Foundation Trust, which is based in Tooting, south London, and has responsibility for Mr Casey’s treatment, asked the judge to rule that it would be lawful to cease artificial ventilation and care.
Barrister Abid Mahmood said brain-stem testing by two specialists had shown that Mr Casey was dead.
Cruelly, the flattering voice of hope convinces those that love Mr Casey that these are signs that Mr Casey is not dead— Mr Justice MacDonald
“This is a tragic matter whereby the trust seeks a declaration that very sadly Andy’s brain-stem function has died and that thereby he has died,” Mr Mahmood told the judge.
“The trust seeks an order that it is lawful for the trust to cease artificial ventilation and care that Andy currently receives.”
Mr Mahmood told the judge in a written case outline that Mr Casey had been involved in a fight in a pub garden on July 9 and was “punched to the head” and “fell to the ground”.
He said specialists had diagnosed death on July 16.
The judge heard that Mr Casey had remained on a ventilator since being injured.
“Whilst I understand fully the conclusions that the family and friends of Mr Casey have, in their sorrow, drawn from his movements and apparent responses to the ventilator, having regard to the totality of evidence before the court, I am also satisfied that what the family are seeing are in fact well-recognised base reflexes that can survive brain stem death,” said Mr Justice MacDonald in a written ruling.
“Cruelly, the flattering voice of hope convinces those that love Mr Casey that these are signs that Mr Casey is not dead.
“With regret, I am satisfied that the brain stem testing undertaken… demonstrate(s) that he is.”
How can someone who reacts to pain be dead?— Christine Casey, Mr Casey’s sister
Mr Justice MacDonald said he had concluded, with “very great sadness” Mr Casey “died on 16 July 2023 at 11.51pm”.
“I understand that this will come as a bitter disappointment to Mr Casey’s family and friends,” he added.
“The now blurred boundary between life and death can be delineated by reference to philosophy, to ethics or to the cardinal tenets of the world’s great religions.
“But the task of this court is to consider whether Mr Casey has crossed over that boundary for the purposes of the law.”
He said he was satisfied, having regard to brain stem testing undertaken in accordance with a code of practice, that Mr Casey had died.
The judge went on: “I recognise that this is a tragedy for his family and friends and, whilst I am certain that it will offer little comfort, they have my profound sympathy.”
Mr Casey’s sister, Christine, 27, said relatives were aiming to appeal.
She said the judge had looked at video footage showing Mr Casey moving.
“He reacts to pain,” she said. “I showed the judge so many videos. How can someone who reacts to pain be dead?”
She added: “We are looking at an appeal.”
