Surreal illustration of a balance scale in a courtroom, weighing medical intervention against patient autonomy.

Second Chance at Life: How a Judge's Decision Gave a Man Another Shot

Soraya Malik in Health & Wellness August 2025 • 4 min read.

"A legal ruling highlights the complexities and ethics of medical decision-making for vulnerable individuals facing life-threatening conditions."

In the intricate dance between law and medicine, decisions concerning patient care often land in the courtroom, particularly when the patient's capacity to decide is compromised. Recently, a High Court judge in the UK made a critical ruling regarding a 43-year-old man, referred to as SJ, who faced imminent danger from septic shock.

SJ, doubly incontinent and battling a recurring cycle of sepsis, was at dire risk. Doctors estimated he had only four to six weeks to live unless a colostomy—a surgical procedure to divert the colon—was performed. However, SJ's ability to make informed decisions was in question, complicated by a history of psychotic episodes and suspected autism spectrum disorder.

This case, presided over by Mr. Justice Moor, brings to the forefront the ethical and legal challenges of balancing patient autonomy with the necessity of medical intervention. The judge's decision to authorize the surgery underscores the gravity of the situation and the complex considerations involved when a patient's life hangs in the balance.

The Weight of the Evidence: A Catastrophic Risk

Surreal illustration of a balance scale in a courtroom, weighing medical intervention against patient autonomy.

The legal proceedings revealed a grim medical picture. SJ had been hospitalized since November 2017, battling sepsis stemming from a severe grade 4 sacral pressure sore. This wound, initially measuring 15 cm by 12 cm and 3 cm deep, reached down to the bone. Despite some improvement over time, the persistent contamination from SJ's bowels posed a significant threat. Doctors described a cycle where feces continuously soiled the wound, leading to bacterial infections that antibiotics couldn't control. They feared an untreatable infection was inevitable.

The urgency of the situation was underscored by the medical consensus. Both the NHS trust caring for SJ and SJ's official solicitor agreed that without the operation, SJ faced a "potential catastrophe." The evidence presented to Justice Moor painted a clear picture: SJ's life was in immediate danger.

Despite the compelling medical evidence, the decision was not straightforward. Several factors weighed heavily on the court:

SJ's expressed desire to avoid the operation due to fear of pain and anesthesia.
His sister, MJ, opposed the surgery, arguing that SJ had the capacity to make his own decisions and that his condition was improving.
A previous judge had refused to authorize the operation due to concerns about the high risk of death from general anesthesia, initially estimated at over 34%.
Since the initial refusal, SJ had lost a significant amount of weight, reducing the anesthetic risk to 2.3%.

Justice Moor faced the delicate task of balancing SJ's wishes, his sister's concerns, and the overwhelming medical evidence. He even took the unusual step of gathering evidence from a consultant surgeon in an unconventional setting—partly in a taxi and partly outside and inside the surgeon's house. The surgeon's stark warning resonated: "If this surgery is not performed, this man will die."

The Judge's Verdict: A Chance for Life

Ultimately, Justice Moor concluded that the evidence overwhelmingly supported the operation. He stated, "Everything points overwhelmingly to him having the operation," emphasizing that there was no indication SJ wished to end his life. The judge added that if SJ could understand the evidence, he would undoubtedly agree to the surgery. The ruling underscores the critical role of the courts in navigating complex medical decisions, particularly when the patient's voice is difficult to discern. It highlights the importance of considering all factors—medical necessity, patient wishes, and ethical obligations—to arrive at a decision that prioritizes the patient's best interests and offers them the best possible chance at life.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/bmj.k4601, Alternate LINK

Title: Judge Rules That Man At Risk Of Septic Shock Within Weeks Should Have Colostomy

Subject: General Engineering

Journal: BMJ

Publisher: BMJ

Authors: Clare Dyer

Published: 2018-10-31

Everything You Need To Know

What were the key factors that led to a judge's intervention in the medical treatment of the man referred to as SJ?

The case involved a 43-year-old man, referred to as SJ, who was at severe risk from septic shock due to a grade 4 sacral pressure sore. Doctors recommended a colostomy to divert the colon and prevent further infection. However, SJ's capacity to consent was compromised by a history of psychotic episodes and suspected autism spectrum disorder. A judge intervened to authorize the surgery, balancing medical necessity with concerns about SJ's autonomy and wishes.

What was the final decision made by Mr. Justice Moor regarding the proposed colostomy for SJ, and what reasoning supported this verdict?

Mr. Justice Moor ultimately authorized the colostomy, after careful deliberation and gathering of compelling medical evidence. He concluded that without the surgery, SJ would die. The judge emphasized that there was no indication SJ wished to end his life, and if he could understand the evidence, he would likely agree to the surgery. This decision underscores the judiciary's role in medical decisions when a patient's voice is difficult to discern.

In the context of SJ's case, what does 'patient autonomy' mean, and how did it influence the legal and ethical considerations?

Patient autonomy refers to a patient's right to make informed decisions about their own medical care. In SJ's case, his autonomy was complicated by his potential lack of capacity due to mental health issues and suspected autism spectrum disorder. Balancing patient autonomy with medical necessity and ethical obligations is a complex legal and ethical challenge, especially when a patient's life is at risk. The judge had to weigh SJ's expressed desire to avoid the operation against the medical consensus that it was necessary to save his life.

How did sepsis specifically endanger SJ's life, and why was a colostomy considered a necessary intervention?

Sepsis, in the context of SJ's case, was a life-threatening complication arising from a severe grade 4 sacral pressure sore. The wound was continuously contaminated by feces, leading to bacterial infections that antibiotics couldn't control. Doctors feared an untreatable infection was inevitable. The colostomy was proposed to divert the fecal stream and allow the wound to heal, thus preventing further episodes of sepsis and giving SJ a chance at survival.

What are some potential long-term implications for SJ's health and quality of life following the colostomy procedure, and what further considerations are important?

While the specifics of SJ's long-term prognosis post-surgery aren't detailed, the ruling emphasizes that the colostomy offered him the best possible chance at life. Further aspects to consider include the potential impact of long term colostomy management. This involves how SJ would manage the colostomy bag, prevent infections, and maintain hygiene, especially given his incontinence and potential cognitive impairments. Long-term care planning and support systems are also vital for SJ's quality of life and overall well-being post-surgery.