Court Decision in A Hospital NHS Trust v Ms KL: Capacity, Restraint, and Best Interests in Medical Treatment

Citation: [2023] EWCOP 59
Judgment on

Introduction

The case of A Hospital NHS Foundation Trust v Ms KL & Anor (2023) EWCOP 59 deals with important legal issues involving capacity to consent to medical treatment, the best interests of a patient, use of restraint, and deprivation of liberty. The decision provides insight into the application of the Mental Capacity Act 2005 (MCA) and the Court of Protection’s role in safeguarding the welfare of individuals who lack capacity to make certain decisions.

Key Facts

Ms KL, a 45-year-old with a complex mental health background, was diagnosed with acute myeloid leukaemia. The hospital trust responsible for her treatment filed an application seeking declarations that Ms KL lacked capacity to consent to chemotherapy and alleged that the treatment was in her best interests. The application included ancillary issues related to restraint and deprivation of liberty. Ms KL’s sister, Mrs KLS, supported the Trust’s case. The court had to decide on capacity, medical treatment, and ancillary issues arising from both.

The court examined:

  1. The principles of mental capacity under the MCA, specifically sections 1-4, which provided the statutory framework for assessing whether an individual has the capacity to consent to medical treatment.
  2. The best interests test under section 4 of the MCA, as elaborated in Aintree University Hospitals NHS Foundation Trust v James ([2013] UKSC 67), emphasizing that welfare includes not just medical concerns but also social and psychological considerations.
  3. The application of the Supreme Court’s decision in A Local Authority v JB ([2021] UKSC52), clarifying that an individual’s inability to make a decision due to impairment or disturbance in the functioning of the mind or brain is the single test for capacity under the MCA.
  4. The jurisprudence concerning a person’s ineligibility to be deprived of liberty under the MCA while on leave from Mental Health Act 1983 detention, which was discussed in An NHS Trust v A ([2015] EWCOP 71) and reinforced in Manchester University Hospital NHS Foundation Trust v JS ([2023] EWCOP 33).
  5. The court also considered the role of restraint per sections 5 and 6 of the MCA in the context of providing medical treatment, following the Practice Guidance (Court of Protection: Serious Medical Treatment) [2020] EWCOP2.

Outcomes

The court concluded that Ms KL lacked the capacity to make an informed decision regarding her medical treatment or to conduct proceedings. This conclusion was based on evidence from medical professionals and consistent with the legal framework of the MCA. Despite the complexity of the case, the court determined that the proposed chemotherapy and restraint associated with its administration were in Ms KL’s best interests. A portacath insertion under general anesthesia was also deemed to be in her best interests, given the usual removal of her PICC lines.

Conclusion

The EWCOP 59 judgment reinforces the importance of a patient’s expressed wishes and feelings in the best interests equation, upholds the hospital trust’s duty of care, and affirms the legal framework’s ability to cater to patients’ welfare against their capacity constraints. It also emphasizes procedural compliance and the necessary obligations of healthcare providers to cooperate seamlessly to serve the best interests of vulnerable individuals. Furthermore, it asserts the court’s role in continuously monitoring such cases, reflecting a thorough and holistic approach to determining best interests in line with statutory mandates and case law.

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