(Family Division; Sir Mark Potter P; 25 May 2006)  FLR (forthcoming)
The 45-year old patient suffered from schizophrenia and was severely delusional. She was diagnosed with a large ovarian tumour, with strong indications that the tumour might be malignant. Although clearly suffering pain and distress she had refused further medical treatment; at times she denied the existence of the problem, at others she explained her refusal by her wish to have children (she already had two children with whom she had no contact). Even if the tumour proved to be benign, without treatment she was likely to die as a result of the impact the cyst was having on her ability to breathe and eat; her condition was also causing her mental state to deteriorate. The experts unanimously agreed that she lacked capacity to give consent to the treatment, and that surgery involving a total abdominal hysterectomy would be in her best interests. The hospital trusts sought a declaration that this medical treatment, and the use of appropriate physical restraint and or sedation, would be lawful.
The patient lacked capacity to make decisions about her medical treatment for the ovarian cyst and her gynaecological condition, failing to appreciate the seriousness of the condition, and the threat to life which it represented. In particular, her assertion that her objection to operative procedure was based on a desire to be able to bear children in the future, like her misplaced belief that she had no children, was delusional. Bearing in mind the positive (not absolute) obligation imposed by Art 2 of the European Convention for the Protection of Human Rights and Fundamental Freedoms 1950 to give life-sustaining treatment where responsible medical opinion was of the view that such treatment was in the patient's best interests, the surgery was in this patient's best interests. The declaration did not cover the forcible administration of chemotherapy contrary to the patient's consent or stated wishes.