Surreal image representing the balance between medical necessity and patient autonomy in a courtroom setting.

Colostomy for Septic Shock? A Judge's Surprising Decision

Soraya Malik in Law & Justice August 2025 • 4 min read.

"A legal ruling allows a man at high risk of septic shock to undergo a colostomy, despite initial reluctance and complex medical considerations."

In a noteworthy legal decision, a High Court judge has granted approval for a 43-year-old man, identified as SJ, to undergo a colostomy. This ruling came after medical experts warned that SJ was at imminent risk of death from septic shock, a severe condition arising from infection.

The case, presided over by Mr. Justice Moor, involved complex considerations, including SJ's medical history, his reluctance towards the procedure, and differing opinions among medical professionals and family members. The ruling underscores the challenges of balancing patient autonomy with the need to prevent life-threatening health crises.

This article delves into the details of the case, exploring the medical background, the legal arguments, and the ethical considerations that led to the judge's decision. It aims to provide a comprehensive understanding of the factors that shaped this critical ruling.

What Led to the Colostomy Decision?

Surreal image representing the balance between medical necessity and patient autonomy in a courtroom setting.

SJ's medical journey involved a series of serious health challenges that ultimately led to the court's intervention. Since November 2017, SJ had been hospitalized due to complications arising from a severe sacral pressure sore. This pressure sore, classified as grade 4, was not only large but also deeply infected, reaching down to the bone. The situation was further complicated by recurring bouts of sepsis.

Sepsis, a life-threatening condition caused by the body's overwhelming response to an infection, posed a significant risk to SJ's life. Doctors discovered a concerning pattern: each time SJ had a bowel movement, the fecal matter would contaminate the wound, leading to recurring septic episodes. These infections were becoming increasingly difficult to treat, raising the specter of antibiotic resistance or another unknown cause.

Initial Concerns: A previous assessment raised alarms about the high risk of death associated with general anesthesia, estimated at over 34%. This led to an initial refusal to authorize the operation.
Improved Prognosis: SJ experienced significant weight loss, dropping to 16 stone, which improved the risk profile associated with anesthesia, reducing it to 2.3%.
Expert Consensus: The NHS trust responsible for SJ's care, along with the official solicitor representing SJ's interests, concurred that the evidence indicated a “potential catastrophe” if the colostomy was not performed.

Despite the medical consensus, SJ voiced his opposition to the colostomy, expressing fear of pain and anesthesia. His sister, MJ, also contested the operation, suggesting that SJ had the capacity to make his own decisions and that his condition could be managed conservatively. These objections added another layer of complexity to an already delicate situation.

The Final Word

Ultimately, Mr. Justice Moor concluded that performing the colostomy was overwhelmingly in SJ's best interests. He acknowledged SJ's fears and objections but emphasized the critical need to prevent a potentially fatal outcome. The judge also highlighted the surgeon's testimony, who stated unequivocally that SJ would die if the surgery was not performed. This ruling reflects the difficult balance between respecting patient autonomy and ensuring necessary medical treatment, particularly when life is at stake.

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Everything You Need To Know

What was the primary medical reason for the colostomy decision for SJ?

The primary medical reason for performing the colostomy on SJ was to prevent septic shock. SJ was at imminent risk of death from septic shock, a severe condition caused by the body's overwhelming response to an infection. Recurring episodes of sepsis, stemming from a grade 4 sacral pressure sore contaminated by fecal matter, posed a significant and life-threatening risk. The colostomy was intended to divert the fecal matter, thus reducing the risk of further infections and, consequently, the septic shock that threatened SJ's life.

Why was there initial reluctance to authorize the colostomy, and how did the situation change?

Initial reluctance to authorize the colostomy stemmed from concerns regarding the risks associated with general anesthesia. Assessments indicated a high risk of death, estimated at over 34% initially. This was a critical factor in the initial refusal to authorize the operation. However, the situation changed significantly when SJ experienced substantial weight loss, reducing the risk profile associated with anesthesia to 2.3%. This improvement, coupled with the consensus among medical professionals and the official solicitor, shifted the balance towards the necessity of the colostomy.

What legal and ethical considerations did Mr. Justice Moor have to balance when making the colostomy decision?

Mr. Justice Moor faced the challenging task of balancing patient autonomy with the need to ensure life-saving medical treatment. He needed to consider SJ's expressed fears and objections to the colostomy, acknowledging the patient's right to make decisions about their own body. Simultaneously, the judge had to weigh the potential for a fatal outcome if the colostomy was not performed, as indicated by medical experts. The ethical dilemma involved respecting SJ's wishes while also protecting their life. The legal framework required the judge to determine whether the colostomy was overwhelmingly in SJ's best interests, despite his objections.

How did SJ's medical history and specific health challenges contribute to the need for a colostomy?

SJ's medical history played a critical role in the colostomy decision. Since November 2017, SJ had been hospitalized due to complications from a severe grade 4 sacral pressure sore. This sore was deeply infected, extending to the bone, and served as a constant source of infection. Furthermore, SJ experienced recurring bouts of sepsis, a life-threatening complication. Each time SJ had a bowel movement, the fecal matter would contaminate the wound, triggering septic episodes. This pattern of infection, combined with the increasing difficulty in treating the infections, made the colostomy a necessary intervention to prevent further contamination and the resulting septic shock.

Who were the key stakeholders involved in this case, and what were their roles?

Several key stakeholders were involved in the case. Mr. Justice Moor presided over the legal proceedings and made the final decision. SJ, the patient, was the central figure, expressing his reluctance to undergo the colostomy. His sister, MJ, also contested the operation, advocating for SJ's autonomy. Medical experts from the NHS trust were responsible for SJ's care and provided medical opinions. The official solicitor represented SJ's interests, adding another layer of representation and providing legal expertise. The surgeon provided critical testimony, highlighting the life-or-death consequences of not performing the colostomy, influencing Mr. Justice Moor's final ruling.