Court of Protection Rules in Favor of Ending Covert Medication and Returning Woman to Mother's Care

Introduction

In the matter of Re A (Covert Medication: Residence) [2024] EWCOP 19, the Court of Protection was tasked with a multifaceted decision about the best interests of a 25-year-old woman, referred to as A, with mild learning difficulties, Asperger’s Syndrome/Autism Spectrum Disorder, and epilepsy. Central to this decision was whether it remained in her best interests to continue living in care (placement A) under covert medication and away from her mother, B, or to return to her mother’s care, with the implications this carried for her ongoing medical treatment.

Key Facts

A had been subject to Court of Protection proceedings for five years and was placed in a specialist care home, separated from her mother, due to an enmeshed relationship, non-compliance with medication, and a deprivation of liberty. Throughout her stay, A consistently refused hormone replacement treatment (HRT), leading the Court to approve its covert administration—a decision not known to her or her mother until revealed by the judge at a later date. The case hinged on determining A’s residence and whether covert medication should continue, including the complexities related to A’s unawareness of this medication and her mother’s application to resume A’s care.

Legal Principles

The case pivoted around several key legal principles, most notably from the Mental Capacity Act 2005 (MCA 2005). The Act defines a person’s best interests with a broad scope, looking beyond just medical outcomes to social and psychological welfare (Aintree University Hospitals NHS Trust v James [2014] AC 591).

In terms of A’s capacity, the Act (Sections 1(5), (6), and 4) mandates that all decisions made on behalf of a person lacking the capacity to decide for themselves must be in their best interests and should be the least restrictive option available. The precedence given to an individual’s wishes, feelings, beliefs, and values, especially under section 4, reflects the importance of personal autonomy (N v ACCG [2017] UKSC 22).

In assessing best interests, the Court considered A’s past and present wishes and feelings, her beliefs and values, as well as the potential for her to gain capacity regarding her treatment decisions in the future. Previous cases, including ITW v Z [2009] EWCOP 2525 and Wye Valley NHS Trust v B [2015] EWCOP 60, reinforced the need to attribute significant weight to the individual’s wishes unless they are outweighed by other factors.

The Court was also mindful of the European Convention on Human Rights, including Article 8 (right to respect for private and family life) and Article 2 (right to life), and the potential infringement upon these rights by the covert medication.

Outcomes

The judgment directed a departure from the status quo, with Mr. Justice Poole taking a nuanced stance on several intertwined determinants. It was declared to be in A’s best interests to cease covert medication, be informed about it, and return to B’s care, subject to detailed planning and supervision to mitigate potential risks and further detriment.

The court’s directive was formed despite acknowledging the possible detrimental health impacts of ceasing HRT and the hovering influence of A’s mother. This critical decision highlighted the statutory imperative of respecting A’s autonomy and family life, believing the potential risks of continued covert medication and deprivation of liberty to be greater than those posed by A’s return home.

Conclusion

Re A (Covert Medication: Residence) [2024] EWCOP 19 encapsulates the delicate balance the Court of Protection must strike in weighing an individual’s welfare in the widest sense against respect for their autonomy and rights. While protective measures are necessary to safeguard individuals without capacity, this case underscores that such protection must not unnecessarily impinge upon human rights and should always promote the person’s best interests, as circumscribed by the MCA 2005, guiding case law, and the need for a wholesome view of welfare that is minimally intrusive. The decision not only threads through the nuances of personal rights vs welfare but also signposts a transformation in A’s life—with a planned return to a less restrictive environment while recognizing the Court’s continuing role in overseeing her welfare.