(Court of Protection, Cobb J, 15 February 2013)
The 21-year-old woman was born was Down's Syndrome and had an associated mild/moderate learning disability. She was cared for at home by her parents and attended a specialist college for people with learning disabilities.
The parents were concerned that as the woman became older their ability to supervise aspects of her life would become reduced and consequently the risks of her engaging in both wanted and unwanted sexual activity would increase. If she were to become pregnant the parents felt it would have serious adverse consequences upon her.
They had attempted to manage the situation by having a hormonal implant inserted into the woman's arm, which was difficult and traumatic for her. The effect of the implant was to change the woman's temperament significantly. After a further traumatic procedure the implant was removed.
The parents then attempted to have the woman sterilised but when faced with medical opinion that sterilisation was not in the woman's best interests the parents considered taking the woman abroad for the procedure to be carried out. The local authority issued proceedings to prevent the woman's removal from the jurisdiction which led the parents to provide undertakings that they would not remove her but proceedings continued to determine whether contraception or sterilisation would be in her best interests.
At the outset of the hearing all parties were in agreement that sterilisation or any form of contraception was not for the time being in the woman's best interests as she was not sexually active or demonstrating any interest in sexual relations.
Having regard to the medical evidence there was no doubt that the woman lacked capacity to understand and weigh up the immediate medical issues. It was in the woman's best interests for the court to bring as much clarity to the medical issues as possible despite the fact that circumstances may arise in the future necessitating a further determination.
Sterilisation would be disproportionate and not the least restrictive step to achieve contraception. Risk management was better than invasive treatment. In the event of a need for contraception arising the least restrictive options should be attempted.
The judge highlighted the importance of a referral to the Court of Protection at the earliest moment in accordance with the Court of Protection Rules 2007. A treatment decision in relation to sterilisation was so serious that the court had to make it and was specifically identified in the Rules.