X NHS Foundation Trust v RH
[2024] EWCOP 150
King's College Hospital NHS Foundation Trust v South London and Maudsley NHS Foundation Trust & Anor
11 April 2024
[2024] EWCOP 20
Court of Protection
A man with a serious leg infection needed an amputation to survive. He was mentally unwell and couldn't decide for himself. The court, after considering his wishes and the medical advice, decided the amputation was the best thing for him.
Key Facts
- •GF, a 60-year-old man with paranoid schizophrenia, was admitted to the hospital with severely infected leg ulcers.
- •Medical professionals recommended an above-the-knee amputation as the only viable treatment option to prevent death from sepsis.
- •GF lacked capacity to make decisions about his care and treatment due to his mental illness.
- •GF's family members supported the amputation.
- •The court considered GF's wishes and feelings, but ultimately prioritized his best interests.
Legal Principles
Presumption of capacity
Mental Capacity Act 2005, s.1(2)
Burden of proof for incapacity
Mental Capacity Act 2005, s.2(4)
All practicable steps to assist in decision-making must be taken
Mental Capacity Act 2005, s.1(3)
Unwise decisions do not automatically equate to incapacity
Mental Capacity Act 2005, s.1(4)
Best interests determination
Mental Capacity Act 2005, s.1(5), s.4
Principle of least restriction
Mental Capacity Act 2005, s.1(6)
Definition of incapacity
Mental Capacity Act 2005, s.2(1)
Best interests considerations
Aintree v James [2013] UKSC 67
Sanctity of life
Airedale Trust v Bland [1993] AC 789
Litigation capacity
An NHS Trust v P [2021] EWCOP 27
Outcomes
GF lacked capacity to make decisions about his care and treatment, including the amputation.
His paranoid schizophrenia impaired his ability to understand, retain, and weigh relevant information regarding his condition and treatment options.
The above-the-knee amputation was deemed lawful and in GF's best interests.
It was the only viable option to prevent death from sepsis, considering the medical evidence, GF's expressed wish to live, and his family's support.