Z NHS Foundation Trust & Anor v Patricia & Ors
[2023] EWCOP 41
Nottingham University Hospitals NHS Trust & Anor v RL & Ors
17 February 2023
[2023] EWCOP 22
Court of Protection
A very sick prisoner wouldn't eat or take his medicine. The judge said he couldn't make his own decisions because he was too unwell, and ordered that he be fed and given medicine through a tube to save his life. The judge will check back in a week to see how he's doing.
Key Facts
- •RL, a man in his thirties serving a life sentence for murder, exhibits severe mental health deterioration including selective mutism, food refusal, and weight loss.
- •RL's condition includes severe malnutrition, refusal of nasogastric feeding and antipsychotic medication deemed essential by his treating team.
- •Medical professionals express concerns about life-threatening risks associated with RL's refusal of treatment, including refeeding syndrome.
- •The court considers RL's capacity to make decisions regarding his treatment.
- •RL displays an inability to communicate his wishes and weigh information related to his treatment, leading to a finding of incapacity.
- •A nasogastric tube was inserted without resistance from RL on the morning of the hearing.
Legal Principles
Presumption of capacity.
Mental Capacity Act 2005 (MCA)
Best interests decision-making for incapacitated individuals.
Mental Capacity Act 2005 (MCA)
Strong presumption in favour of preserving life.
Case law and common law principles
Incapacity is determined by inability to weigh information or communicate a decision due to mental illness.
Mental Capacity Act 2005 (MCA)
Outcomes
Declaration of incapacity under section 15 MCA.
RL's inability to weigh information or communicate a decision regarding treatment due to his mental illness.
Authorization for administration of nasogastric feeding, antipsychotic medication (Olanzapine and Lorazepam), Carbimazole, thyroid medication and Pabrinex.
Best interests determination, weighing the strong presumption in favor of preserving life against the difficulty in ascertaining RL's wishes.
Authorization for the use of restraint to reinstate the NGT if it becomes displaced.
Necessary to ensure the administration of essential medication and nutrition.