University Hospitals Southampton NHS Foundation Trust v T & Ors
[2023] EWCOP 54
A Hospital NHS Foundation Trust v Ms KL & Anor
22 December 2023
[2023] EWCOP 59
Court of Protection
A woman with learning difficulties and a serious illness needed urgent chemotherapy. The court decided she couldn't make the decision herself, so they ordered the treatment because it was in her best interests to stay alive. They also approved a less painful way to give the medicine and made sure her rights were protected.
Key Facts
- •Ms KL, a 45-year-old woman with learning disabilities and Emotionally Unstable Personality Disorder (EUPD), was diagnosed with acute myeloid leukaemia.
- •She lacks capacity to consent to treatment.
- •Her sister supports the applicant's case.
- •The applicant, a hospital NHS Foundation Trust, sought declarations that Ms KL lacks capacity and that proposed chemotherapy is in her best interests.
- •Significant procedural issues arose due to late filing of documents and breaches of court orders.
- •Ms KL requires further chemotherapy cycles, and the insertion of a portacath is considered.
Legal Principles
Mental Capacity Act 2005 (MCA): Determining capacity requires identifying the 'matter' of the decision, relevant information, and whether inability to decide stems from impairment of mind/brain.
A Local Authority v JB [2021] UKSC 52; North Bristol NHS Trust v R [2023] EWCOP 5
Best interests test under MCA: Considers patient's welfare (medical, social, psychological), treatment nature/prospects, likely outcome, patient's likely attitude, and views of carers.
Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67
Deprivation of Liberty Safeguards (DOLS): Eligibility for DOLS even if on leave from Mental Health Act detention for physical treatment.
An NHS Trust v A [2015] EWCOP 71; A Hospital NHS Trust v CD [2015] EWCOP 74
Standard for assessing capacity should not be set too high; only salient factors need to be understood.
KK v STC and Others [2012] EWHC 2136 (COP)
Outcomes
Ms KL lacks capacity to consent to chemotherapy and to conduct proceedings (s.15 declaration).
Evidence from multiple doctors and the lack of understanding of her condition and treatment.
Further chemotherapy cycles are in Ms KL's best interests (s.16 order).
Weighing Ms KL's wish to live, the high risk of death without treatment, and the support from her family and medical team.
Portacath insertion under general anaesthetic is in Ms KL's best interests.
Reduces trauma of repeated PICC line insertions, outweighing anaesthetic risks.
Deprivation of liberty is authorised.
Necessary for chemotherapy treatment; Ms KL is not ineligible under Schedule 1A MCA.
Review hearing scheduled to address restraint and ensure proper management of treatment.
Multiple breaches of court orders caused concern for Ms KL's welfare.