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.