North Middlesex University Hospital NHS Trust & Anor v MB
[2023] EWCOP 23
Mid Yorkshire Teaching NHS Trust v SC & Anor
1 November 2024
[2024] EWCOP 69 (T3)
Court of Protection
A pregnant woman with mental health problems didn't want a C-section, but doctors said it was necessary to keep her and her baby safe. Because she was unable to make decisions due to her illness, the judge decided it was in her best interest to have the C-section, even though it went against her wishes.
Key Facts
- •SC, a 37-year-old pregnant woman with a history of mental health issues and two previous C-sections, was detained under the Mental Health Act.
- •An ultrasound revealed static foetal growth, necessitating urgent delivery by November 4th.
- •SC lacks capacity to decide on a C-section due to mania with psychotic symptoms and delusional beliefs.
- •SC's expressed wish is for a natural birth, fueled by her delusional belief that she's carrying quadruplets.
- •Medical professionals strongly recommend a planned C-section to minimize risks to both mother and baby.
- •The local authority plans to remove the baby from SC's care after birth.
Legal Principles
Mental Capacity Act 2005 (MCA 2005): A person lacks capacity if unable to make a decision due to an impairment of, or disturbance in, the mind or brain.
MCA 2005, sections 1-3
Best interests determination under MCA 2005 considers all relevant circumstances, including past and present wishes, beliefs, values, and reasonably foreseeable consequences for the individual and others.
MCA 2005, section 4; Aintree University Hospitals NHS Foundation Trust v James [2014] UKSC 67
Determining capacity is decision-specific and considers whether the individual understands, retains, uses, and weighs relevant information and can communicate their decision.
A Local Authority v JB [2021] UKSC 52; North Bristol NHS Trust v R [2023] EWCOP 5
If a person does not believe objectively verifiable medical information, they may lack capacity to understand and weigh it.
Hemachandran v Thirumalesh [2024] EWCA Civ 896
Authorizing a C-section is a serious interference with personal autonomy and Article 8 rights.
North Bristol NHS Trust v R [2023] EWCOP 5
Outcomes
The court granted the application for a planned C-section.
The court found that SC lacked capacity due to her mental illness and delusional beliefs, and that a C-section was in her best interests given the significant medical risks to her and her baby. The risks of a deterioration in her mental health were weighed against the medical risks of delaying the C-section.