Mid Yorkshire Teaching NHS Trust v SC & Anor
[2024] EWCOP 69 (T3)
A Hospital Trust v CP & Anor
14 February 2024
[2024] EWCOP 7
Court of Protection
A pregnant woman with mental health problems couldn't decide on her delivery. A judge decided a planned C-section with a spinal block was safest and best for her, even though she initially wanted a natural birth. Her parents weren’t involved in the decision-making process.
Key Facts
- •CP, a 30-year-old pregnant woman with schizophrenia, lacks capacity to make decisions regarding her obstetric care.
- •CP is detained under section 3 of the Mental Health Act 1983.
- •The application concerns a planned Cesarean section.
- •CP's parents initially sought to be joined as parties but were not.
- •CP expressed a wish for a pre-arranged Cesarean section with a spinal block.
- •Clinicians and the court considered the best interests of CP and her baby.
- •A planned Cesarean section with a spinal block was deemed to be in CP's best interests.
Legal Principles
An adult of sound mind can make decisions about their medical treatment, even if harmful.
Re F (Mental Patient: Sterilisation) [1990] 2 AC 1
A person lacks capacity if, at the material time, they are unable to make a decision for themselves because of an impairment of, or a disturbance in the functioning of, the mind or brain.
Mental Capacity Act 2005 (MCA), sections 1-3
A person is not treated as unable to make a decision merely because they make an unwise one.
MCA, section 1(4); Heart of England NHS Foundation Trust v JB [2014] EWHC 342 (COP)
When determining best interests, consider all relevant circumstances, past and present wishes and feelings, beliefs and values, and other factors the person would likely consider if capable.
MCA, section 4(6)
Account must be taken of the views of anyone engaged in caring for the person or interested in their welfare.
MCA, section 4(7)
In best interests decisions, there's a strong presumption in favour of life-sustaining treatment, but this is not absolute.
Aintree v James [2013] UKSC 6
Outcomes
CP lacks capacity to conduct proceedings and make decisions regarding her obstetric care.
CP's schizophrenia impairs her ability to weigh information and make informed decisions.
CP's parents were not joined as parties.
Their joinder would not better enable the court to deal with the application, and CP opposed it.
A pre-arranged Cesarean section with a spinal block is in CP's best interests.
This minimizes pain, maximizes safety, and allows for better management of CP's mental health needs. A natural birth would pose significant risks due to CP's non-compliance and poor pain tolerance.