Maisie is a 17 year old girl with autism and ADHD. She has complex learning disabilities. Maisie is extremely sensitive to anything on her skin, which means that if a dressing is applied to her or an IV is inserted she becomes very agitated and tends to pick at the dressing or pull out the line. Sudden changes in her routine and living arrangements are very distressing to Maisie, resulting in a tendency to become very upset and physically aggressive.

Three years ago, Maisie was diagnosed with a condition which has caused her kidneys to begin to fail. Up until now, she has been having haemodialysis several times per week. However, her tendency to pull out the IV lines means that the majority of the access points for the lines have now been used, and within the next six months haemodialysis will no longer be possible. Once haemodialysis fails, Maisie will die.

The only alternative treatment is a kidney transplant, which would be estimated to give Maisie another 8-20 years of life. As well as being an invasive treatment in itself, if Maisie tampers with the IV lines which will be required after the operation the success of the transplant could be at risk. There is also a risk that the condition would reoccur in the days following the transplant, meaning that more haemodialysis and also plasma exchange would be required. Both these procedures would mean that Maisie would be hooked up to IVs for many days.

It is therefore felt that the only way for Maisie to have a kidney transplant without being put at serious risk is to be kept under sedation and ventilation for at least five days but up to two weeks if her condition reoccurs. Long term ventilation and sedation like this is not usually done on an elective basis, because of the potential life threatening physical side effects. In addition, because someone who is sedated and ventilated is not unconscious, the treatment can have a huge impact psychologically. It is the view of some experts that the psychological impacts of long term ventilation could be so harmful that Maisie would never be persuaded to go into hospital again.

Maisie's family want to proceed with the transplant, but her treating team of doctors are not sure that this in her best interests. When asked about the treatment, Maisie just says "I don't know" or "Whatever you want".

Critically analyse the arguments which would be raised in relation to Maisie's treatment.

- Mental health law