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Trust A and Another v H (An Adult Patient) [2006] EWHC 1230 (Fam)

Declaration that schizophrenic patient lacked capacity to make decisions about medical treatment granted.

Family Division: Sir Mark Potter P (25 May 2006)

Summary
Declaration that schizophrenic patient lacked capacity to make decisions about medical treatment granted.

Background
This case concerned a 45-year-old female patient who suffered from schizophrenia and, as a result, was delusional. In early 2005, she complained of a distended abdomen, but refused any blood tests or further investigations. By December 2005, she was suffered from intense abdominal pain; at that stage, she received in-patient treatment, and a CT scan confirmed a large ovarian tumour with strong indications that the tumour might be malignant and that she was suffering from ovarian cancer.

The patient was advised that she needed surgery to remove the tumour, but she adamantly refused. Accordingly, the Primary Care Trust and the Hospital NHS Trust applied to the court for a declaration: (1) that the patient lacked capacity to make decisions about her medical treatment for the ovarian cyst and her general gynaecological condition; (2) that it was in the patient's best interests to receive the recommended medical treatment; and (3) that it was lawful for those delivering such medical treatment to provide sedation and, if necessary, reasonable physical restraint, in order to administer pre- and post-operative treatment.

A gynaecological report was prepared jointly by the consultant responsible for the patient's care and by a consultant in the independent sector who was instructed as an independent expert by the Official Solicitor (representing the patient as her litigation friend). A joint agreed report on the patient's mental condition was also prepared, and there were reports from a consultant clinical oncologist and a consultant anaesthetist.

There was essentially a unanimous view between the medical experts concerned with the patient's care that the surgery proposed was in her best interests and should be performed without delay. Similarly, all were agreed that she lacked capacity to make decisions about her medical treatment for her ovarian cyst and gynaecological condition. Further, the Official Solicitor accepted these opinions, and believed it to be in the patient's best interest that if, as expected, she continued to withhold consent to operative treatment, she should be sedated for that purpose and, if necessary, there should be use of reasonable physical restraint in order to administer pre- and post-operative treatment.

Findings
In view of the medical evidence, the President was satisfied that the patient lacked capacity to make decisions about her medical treatment, as it was clear that she did not appreciate the seriousness of her condition and the sense of threat to life which it presented if not alleviated by the recommended surgery.

The President was also satisfied that it was in the patient's best interests to undergo the surgery, bearing in mind the positive (though not absolute) obligation imposed by Article 2 of the European Convention on Human Rights to give life-sustaining treatment where responsible medical opinion was of the view that such treatment was in the patient's best interests. At law, 'best interests' were not confined to best medical interests, and needed to take into account a broad spectrum of medical, social, emotional and welfare issues. The President reached his conclusion after weighing the advantages and disadvantages that emerged from the evidence before him.

The President therefore granted the declaration in the terms sought; however, he made it clear that, if post-operative chemotherapy were required and the patient resisted it, forcible administration of such treatment was not covered by the declaration, and a return to court to resolve the issue might be appropriate.

Digest prepared by Peter Smith

Read the full text of the judgment here