GH (Mastectomy: Best Interests: Costs), Re
[2023] EWCOP 50
PG (Serious Medical Treatment), Re
29 August 2024
[2024] EWCOP 49 (T3)
Court of Protection
A woman with severe mental illness and possible cancer refused treatment. The court decided it's better to focus on her comfort and happiness now, rather than trying to force medical procedures that would likely make her much worse, even if it means her cancer may not be treated.
Key Facts
- •PG, a 57-year-old woman with a history of severe and treatment-resistant schizophrenia and potential gynaecological malignancy, lacks capacity to make decisions about her medical treatment.
- •PG exhibits strong resistance to medical investigations and treatment due to delusional beliefs.
- •She is currently residing in a supported living placement, where she is doing relatively well.
- •Medical professionals suspect PG has stage 4 vulval cancer, with a poor prognosis if left untreated.
- •Treatment options such as surgery, chemotherapy, and radiotherapy are considered impractical due to PG's resistance and potential detrimental impact on her mental health.
Legal Principles
Mental Capacity Act 2005 (MCA 2005), sections 1-3, defining capacity and best interests.
MCA 2005
Best interests determination under section 4 MCA 2005, considering past and present wishes, feelings, beliefs, and values.
MCA 2005, section 4
Aintree v James [2013] UKSC 67: Best interests are not just medical but also social and psychological; the court must consider the patient's attitude to treatment and consult others.
Aintree v James [2013] UKSC 67
A Local Authority v JB [2021] UKSC 52: Provides a detailed exposition of the fundamental principles of the Mental Capacity Act 2005.
A Local Authority v JB [2021] UKSC 52
Outcomes
PG lacks capacity to conduct the proceedings and consent to medical treatment.
PG's severe and enduring mental illness impairs her understanding, retention, and use of information regarding her medical condition.
It is not in PG's best interests to undergo investigations or treatment for suspected gynaecological malignancy.
The potential psychological harm from investigations and treatment outweighs the potential benefits, given PG's strong resistance and the low likelihood of compliance with treatment. Furthermore, any treatment is likely to be futile or overly burdensome.
PG will receive palliative care.
This approach prioritizes PG's current well-being and minimizes further distress, while acknowledging the likely progression of her suspected cancer.
A community deprivation of liberty order will be made.
This allows PG's Section 3 MHA 1983 order to be discharged, freeing up a hospital bed and enabling her continued care in the supported living placement.