Assessment Of Capacity When Refusing Medical Treatment

It is generally accepted that an individual is able to refuse medical treatment as a result of their religious beliefs. This is even the case for life saving treatment which has been seen across case law over the years.

However, the recent case of NHS Foundation Trust v C (by her litigation friend, the Official Solicitor) and another confirms what will be taken into account when the individual in question is presumed to lack the requisite capacity.

NHS Foundation Trust v C (by her litigation friend, the Official Solicitor) and another

The individual in question, C, had been previously diagnosed to have paranoid schizophrenia. C was in her 60’s and lived alone.

Whilst C was diagnosed as having paranoid schizophrenia, it was accepted that C maintained a level of capacity and was, at times, able to make her own decisions in respect of medical treatment despite having been previously been detained under the Mental Health Act.

Towards the end of 2019, C had been diagnosed with grade 2 endometrial cancer and it was agreed that C should have her ovaries and fallopian tubes removed. Further to this, it was recommended that radio therapy should begin six weeks after surgery. At the time of diagnosis, C agreed to go ahead with the operation, which was planned for March 2020. It is agreed that C had requisite capacity to make such decisions at the time of agreeing to the treatment.

Leading up to the treatment, C began to insist that she did not want the treatment due to her religious beliefs, and stressed that only God could cure her. Although refusal of the treatment would have inevitably led to C’s early death, on the face of it C would be able to make such decision under the Mental Capacity Act. A psychiatrist however concluded that at this point C was unable to weigh the information available to her to make an informed decision (s.3(1) MCA) and therefore C was deemed to lack capacity in respect of such decision.

The Court believed that C appeared to have requisite capacity when initially agreeing to the treatment and C had therefore shown a want to live. The Court also began to look further into C’s life to determine what ordinary decision C would have taken if she had capacity. Given that the outcome of success was likely for the treatment, the Court held that treatment was in C’s best interest and further C would ordinarily have wanted to survive. The NHS would therefore prepare a plan to carry out the treatment for the Judges approval.

Comment

This case shows the detail the Court will look at when considering ones capacity in refusing life sustaining treatment and reinforces the preservation of life where possible. There is no doubt however that if C was shown to have requisite capacity, then she would have been allowed to have refused such treatment.