PG (Serious Medical Treatment), Re
[2024] EWCOP 49 (T3)
University Hospitals Southampton NHS Foundation Trust v T & Ors
17 November 2023
[2023] EWCOP 54
Court of Protection
A woman with a learning disability needs urgent cancer treatment, but the most important part is very invasive. Because she can't understand the treatment, the court decided for her. Weighing her chances of getting better against the risks, and considering how much she loves her family, the court said the treatment, even with the invasive part, is the best thing for her.
Key Facts
- •Miss T, a 60-year-old woman with a lifelong moderate-severe learning disability, was diagnosed with advanced cervical carcinoma.
- •She requires urgent two-stage treatment: five weeks of radiotherapy and chemotherapy (stage 1), followed by high-dose rate brachytherapy (stage 2).
- •Stage 2 is highly invasive and requires ventilation and sedation for three days, which necessitates court authorization due to Miss T's lack of capacity.
- •Miss T's family supports the treatment, but concerns exist about the invasive nature of the procedure and potential side effects.
- •The court considered evidence from oncologists, anaesthesiologists, and learning disability nurses, as well as a capacity assessment.
Legal Principles
Mental Capacity Act 2005 (MCA 2005): Sections 1-4 establish the framework for assessing mental capacity and best interests.
Sections 1-4, MCA 2005
Capacity principles under MCA 2005, as clarified by the Supreme Court in A Local Authority v JB [2022] AC 1322 and applied in North Bristol NHS Trust v R [2023] EWCOP 5: The court must identify the “matter” of the decision, the relevant information, and whether the individual's inability to decide stems from a mental impairment.
A Local Authority v JB [2022] AC 1322; North Bristol NHS Trust v R [2023] EWCOP 5
Best interests test under MCA 2005 and Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67: Considers welfare in the widest sense (medical, social, psychological), treatment prospects, likely outcomes, the patient's likely attitude (if ascertainable), and views of carers.
Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67
Balancing Article 8 (right to respect for private and family life) and Article 10 (right to freedom of expression) of the European Convention on Human Rights (ECHR) in relation to reporting restrictions.
Article 8 and 10 ECHR
Deprivation of Liberty safeguards under MCA 2005.
MCA 2005
Outcomes
Miss T lacks capacity to consent to the proposed treatment, including ventilation and sedation.
Based on capacity assessment showing inability to retain and weigh relevant information due to her learning disability.
The proposed treatment (stages 1 and 2, including ventilation and sedation) is in Miss T's best interests.
Weighing the significant chance of a 40% 5-year survival rate against the alternative of palliative care and months to live, considering her family life and values.