Court Upholds Best Interests Principle in Case of Medical Treatment for Incapacitated Individual

Citation: [2024] EWCOP 1
Judgment on


The case of Re TTN ([2024] EWCOP 1) provides a nuanced demonstration of the Court of Protection’s application of legal principles concerning medical treatment for an individual who lacks capacity. The Honourable Mr Justice Cobb presided over the matter, which centered on whether it was in the best interests of the patient, TTN, to undergo vitrectomy surgery for a detached retina, including considerations about the lawful use of sedation and restraint during his transfer and treatment.

Key Facts

TTN, a 73-year-old man with a history of mental disorder and blindness in one eye, faced the prospective loss of vision in his other eye due to a detached retina. With his remaining sight critically limited, a vitrectomy was proposed. TTN was admitted under section 3 of the Mental Health Act 1983 and lacked capacity to make decisions regarding the surgery. There was no doubt about his lack of capacity, which was predicated on his fixed delusional beliefs that impeded his ability to make informed decisions.

The applicants sought declarations that TTN lacked both litigation and capacity to consent to the surgery and that sedation and restraint were lawful and in his best interest for the transfer to the surgical venue. TTN’s brother supported the operation, and the Official Solicitor, representing TTN, agreed that the surgery was in his best interests despite TTN’s own complex views on the matter.

Mental Capacity Act 2005 (MCA 2005)

The judgement in Re TTN underscores the principles contained within the Mental Capacity Act 2005. These include the presumption of capacity and the necessity to take all practicable steps to help someone make a decision before declaring them incapable. Furthermore, a person is not deemed incapable solely based on unwise decisions, or due to an impairment or disturbance in mental functioning. Should a person be unable to understand, retain, weigh, or communicate decisions related to relevant information, they would be considered as lacking capacity.

Best Interests

The ‘best interests’ principle, as outlined within the MCA 2005, requires consideration of all relevant circumstances without making assumptions based solely on the individual’s condition. The person’s past and present wishes and feelings, beliefs, and values must be considered, and as far as possible, the decision should be what the person would have made if they had capacity.

Deprivation of Liberty

The court also considered the issue of deprivation of liberty, evaluating whether the sedation and physical restraint necessary to transfer TTN to the hospital for treatment constituted the least restrictive option to ensure a safe procedure, aligning with Article 5 of the European Convention on Human Rights.

Serious Medical Treatment Guidance ([2020] EWCOP 2)

The case adheres to the Serious Medical Treatment Guidance ([2020] EWCOP 2), marking it as a decision within that bracket, owing to the seriousness of the medical treatment proposed and its implications.


The court determined that TTN lacked the capacity to make the decision regarding the surgery, primarily due to his psychiatric condition and the fixed delusions that impaired his decision-making ability. Consequently, it was in TTN’s best interests to proceed with the proposed medical treatment. This included sedation and potential restraint, deemed lawful and necessary parts of the treatment plan, particularly given the need to avoid any additional distress or resistance from TTN.


In conclusion, the court upheld the paramountcy of the best interests principle in decision-making for individuals lacking capacity, while also navigating the complexities inherent in each unique case. The ruling balances the individual’s welfare and human rights with the medical imperative for timely and potentially life-altering treatment. The decision in Re TTN ([2024] EWCOP 1) serves as a testament to the court’s meticulous approach to upholding the law while ensuring that the welfare of those who cannot speak for themselves remains at the forefront of its considerations.

Related Summaries