Symbolic representation of a legal gavel intertwined with medical tubing and a human silhouette.

Colostomy: When Is It Necessary to Save a Life?

Theo Raines in Health & Wellness November 2025 • 4 min read.

"A High Court ruling highlights the critical role of colostomy in managing severe septic shock risks"

In a compelling case that brings medical ethics and legal judgment into sharp focus, a High Court judge in the UK recently ruled in favor of performing a colostomy on a 43-year-old man. The patient, referred to as SJ, faced a dire prognosis: doctors feared he would succumb to septic shock within weeks if the procedure wasn't carried out. This decision, while potentially life-saving, raises complex questions about patient rights, the severity of medical risks, and the role of the courts in healthcare decisions.

The ruling, initially made in August and recently brought to public attention, underscores the critical balance between preserving an individual's autonomy and providing necessary medical intervention. SJ, who has a history of psychotic episodes and suspected autism spectrum disorder, was deemed by the court to lack the capacity to make informed decisions about his medical treatment. This determination paved the way for the judge to weigh the benefits of the colostomy against SJ's expressed wishes and his sister's advocacy for more conservative management.

This article delves into the details of the case, exploring the medical rationale behind the colostomy recommendation, the legal considerations that influenced the judge's decision, and the broader implications for patients facing similar life-threatening conditions. It examines the difficult choices that healthcare professionals, legal authorities, and families must navigate when a patient's life hangs in the balance.

What is Septic Shock and Why Was Colostomy Recommended?

Symbolic representation of a legal gavel intertwined with medical tubing and a human silhouette.

Septic shock is a severe condition that occurs when an infection leads to a dangerously low blood pressure and organ dysfunction. It's a life-threatening complication of sepsis, the body's overwhelming response to an infection. In SJ's case, the primary cause was a large, necrotic, infected grade 4 sacral pressure sore. This severe bedsore created a significant risk of recurring sepsis.

The ongoing infection was difficult to manage because each time SJ had bowel movement it soiled the edge of wound, continuously contaminating it with bacteria. Despite treatment with various antibiotics, doctors were concerned about the development of antibiotic resistance or other factors that could render the infection untreatable. Given this situation, a colostomy—a surgical procedure that diverts the flow of stool away from the affected area—was recommended to prevent further contamination and reduce the risk of septic shock.

Reducing Infection Risk: Diverting stool away from the sacral pressure sore would minimize bacterial contamination and promote healing.
Preventing Septic Shock: By controlling the source of infection, the colostomy aimed to prevent further episodes of life-threatening septic shock.
Improving Quality of Life: While a significant procedure, the colostomy offered the potential to improve SJ's overall condition and quality of life by addressing the underlying cause of his recurring sepsis.

The urgency of the situation was underscored by the medical team's assessment that SJ was at risk of dying from septic shock within a matter of weeks if the colostomy was not performed. This dire prognosis weighed heavily in the court's decision-making process.

Balancing Risks and Rights: The Ethical Tightrope

The High Court's decision to approve the colostomy for SJ highlights the complex ethical considerations that arise when a patient lacks the capacity to make their own medical decisions. While respecting patient autonomy is paramount, healthcare professionals and legal authorities must also act in the best interests of the patient, especially when their life is at stake. This case serves as a reminder of the difficult choices that must be made in such situations and the importance of careful evaluation, expert medical opinion, and a thorough understanding of the patient's individual circumstances.

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Everything You Need To Know

What is a colostomy and why was it considered essential for SJ?

A colostomy is a surgical procedure that diverts the flow of stool away from the body's normal route. In SJ's case, it was recommended because he had a large, necrotic, infected grade 4 sacral pressure sore. His recurring bowel movements were continuously contaminating the wound with bacteria, leading to ongoing sepsis. The colostomy aimed to reduce the risk of septic shock by minimizing bacterial contamination and promoting the sore's healing. This approach was deemed critical to preventing further episodes of life-threatening septic shock.

What is septic shock, and how does it relate to the High Court's decision regarding SJ?

Septic shock is a life-threatening condition that occurs when an infection leads to dangerously low blood pressure and organ dysfunction. The High Court's decision was significantly influenced by the fact that SJ was at high risk of dying from septic shock within weeks if the colostomy was not performed. The severity of the risk, combined with SJ's lack of capacity to make informed decisions about his treatment, prompted the judge to weigh the benefits of the colostomy against his expressed wishes and his sister's perspective.

Why was SJ deemed unable to make his own medical decisions, and how did this impact the legal process?

SJ was deemed to lack the capacity to make informed decisions about his medical treatment due to his history of psychotic episodes and suspected autism spectrum disorder. This determination was crucial because it meant the court had to step in and make decisions on his behalf. The court had to consider SJ's best interests, evaluate the medical rationale behind the colostomy recommendation, and consider his sister's input. This situation highlights the legal framework that addresses patient autonomy and life-saving interventions when a patient cannot make decisions for themselves.

What were the key medical and ethical considerations that the court had to balance when deciding on SJ's colostomy?

The court had to balance the principle of patient autonomy with the need to provide life-saving medical intervention. Ethical considerations included weighing SJ's expressed wishes against the dire prognosis of septic shock, the medical team's recommendations, and the potential benefits of a colostomy. The medical considerations revolved around the risks associated with the infected pressure sore, the urgency of preventing septic shock, and the potential for improving SJ's overall condition. The decision also considered the potential quality of life improvements that the colostomy could offer, despite it being a significant procedure.

Beyond SJ's case, what are the broader implications of this High Court ruling for other patients and healthcare providers?

This ruling underscores the complex ethical considerations and legal frameworks that healthcare professionals and legal authorities navigate when a patient's life is at stake and the patient lacks the capacity to make their own decisions. It highlights the importance of expert medical opinion, careful evaluation of the patient's individual circumstances, and the balance between preserving patient autonomy and ensuring necessary medical interventions. It serves as a reminder of the need for clear guidelines and processes to protect patient rights while also enabling life-saving treatments in challenging circumstances. The ruling reinforces that similar cases should be handled with extreme care, considering all aspects of the patient's well-being, and the necessity of collaboration between medical professionals, legal experts, and family members.