Manchester University NHS Foundation Trust v Y (By his litigation friend, the Official Solicitor)
[2023] EWCOP 51
X NHS Foundation Trust v RH
5 February 2024
[2024] EWCOP 150
Court of Protection
A man with mental illness needs urgent kidney surgery but refuses due to his illness. The court decided the surgery is in his best interest even though it means using restraint to help him have the operation, because the surgery is needed to save his life. The court considered his wishes but ultimately prioritized his health and safety.
Key Facts
- •RH, a 40-year-old man with hebephrenic schizophrenia and severe kidney issues, is detained under the Mental Health Act 1983.
- •The NHS Trust applied for declarations that RH lacks capacity to consent to treatment and for orders authorizing treatment and restraint.
- •RH's condition requires urgent urological surgery, but he lacks capacity and refuses treatment due to delusional beliefs.
- •The application process was initially chaotic, with late filings and an incomplete care plan.
- •The court heard evidence from RH's treating psychiatrist, urologist, anesthesiologist, and a mental health nurse.
- •RH's mother supports the proposed treatment.
Legal Principles
Capacity assessment under sections 1-3 of the Mental Capacity Act 2005 (MCA)
MCA
Best interests assessment under section 4 of the MCA, considering past and present wishes, beliefs, values, and relevant circumstances.
MCA
A lack of capacity does not negate a person's wishes and feelings.
Wye Valley NHS Trust v Mr B [2015] EWCOP 60
Wishes and feelings are given great respect but are not always determinative of best interests; the weight given varies based on the context.
M v N [2015] EWCOP 9
In best interests decisions, consider welfare in the widest sense (medical, social, psychological); the nature of the treatment; its prospects of success; the likely outcome; the patient's attitude; and views of carers.
Aintree University Hospitals NHS Trust v James [2013] UKSC 67
Restraint under section 63 of the Mental Health Act 1983 (MHA).
MHA
Outcomes
RH lacks capacity to make decisions about his admission, treatment, and litigation.
Evidence showed RH's delusional beliefs prevented him from understanding and weighing the relevant information.
The proposed urological surgery and related care are in RH's best interests.
The potential benefits of preventing kidney failure outweigh the risks of the procedure, even with the need for restraint.
Use of physical and chemical restraint is authorized.
Restraint is necessary and proportionate to ensure the safe delivery of treatment, given RH's non-compliance and delusions.