Court Upholds Best Interests Over Capacity in Life-Saving Medical Treatment Case

Citation: [2023] EWCOP 54
Judgment on

Introduction

In the case of University Hospitals Southampton NHS Foundation Trust v T & Ors [2023] EWCOP 54, the Court of Protection was presented with a complex and sensitive issue concerning the medical treatment of an individual lacking capacity due to a significant learning disability. This case provided a thorough examination of the principles established under the Mental Capacity Act 2005 (MCA 2005), while also upholding the subject’s rights as enshrined within the European Convention on Human Rights (ECHR), specifically in relation to Article 8.

Key Facts

Miss T, a woman with moderate-severe learning disability, was diagnosed with advanced cervical carcinoma and required urgent cancer treatment. Her treatment was to be conducted in two stages, with stage two deemed highly invasive, painful, and distressing, requiring sedation and ventilation over a three-day period. An application by the treating hospital sought declarations regarding Miss T’s capacity and best interests concerning her treatment under the MCA 2005. Additionally, considerations of her liberty and family support were pivotal in the ruling, reflecting the necessity of such treatment to extend her life expectancy.

The key legal principles relevant to this case involve the assessment of capacity to consent to medical treatment, best interests determinations, and the appropriate balance of ECHR rights, notably the right to respect for private and family life.

  1. Mental Capacity Act 2005: The case revolved around the application of the MCA 2005, particularly sections 1-4 relating to mental capacity and best interests. Section 2(1) sets out the ‘single test for capacity’, requiring a person to comprehend and retain the information relevant to the decision, evaluate such information and communicate their consent. In the context of Miss T’s circumstances, her inability to retain information and assess the implications of her treatment rendered her incapacitous as per the MCA 2005.

  2. Best Interests Test: The best interests test under MCA 2005 were guided by the principles outlined in Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67 and subsequent case law. The court considered factors such as the nature of the medical treatment, its prospects of success, Miss T’s likely wishes, feelings, beliefs, and values, as well as the views of her family. In evaluating best interests, the court accorded significant weight to the views of healthcare professionals and the unanimously supported proposed treatment plan.

  3. Deprivation of Liberty: Though not a primary focus of this particular judgment due to procedural expediency, deprivation of liberty safeguards under the MCA 2005 were acknowledged. The court briefly mentioned that any deprivation of liberty resulting from inpatient care or sedation would need to be addressed through standard procedures outlined in the Act.

  4. Human Rights Considerations: The judgment integrated a thorough ECHR Article 8 scrutiny within the best interests analysis. It acknowledged the gravity of authorising potentially life-extending medical treatment against the backdrop of somewhat invasive methods necessary to carry out such treatment.

Outcomes

The court concluded that Miss T lacked the capacity to consent to the treatment. Given the invasive nature of stage 2, the necessity for sedation and ventilation was authorised, as it was determined to be in Miss T’s best interests. The prognosis without treatment was a short life expectancy, making preservation of life a considerable factor. The unique profile of the patient, her familial connections, and the proposed advantages of the treatment supported the judgment that the stage 1 and 2 treatments were in her best interests, surpassing the merits of palliation.

Conclusion

This case embodies the intricate balance required in the intersection of medical ethics, law, and human rights. The Court of Protection’s application of the MCA 2005’s principles regarding capacity and best interests, with due regard for ECHR rights, demonstrated a careful and detailed approach to ensuring the lawful and ethical treatment of those who lack mental capacity. The commendable judicial diligence to uphold the patient’s best interests and the sanctity of life underlines the court’s role in protecting the vulnerable, reflecting a compassionate embrace of the statutory mandate and human rights obligations within the UK legal framework.