Court rules that doctors can operate on a woman who has a fear of hospitals
Court rules 55-year-old woman with learning difficulties can be coercively sedated in order to have life-saving cancer surgery. A high court judge today gave doctors permission to forcibly sedate a woman who has a phobia of hospitals at her home, so that she can be taken for cancer surgery against her will.
The highly unusual judgement by Sir Nicholas Wall, head of the court's family division, said that if the 55-year-old woman, who has a significant learning difficulty, continued to refuse treatment, then an ambulance crew could be sent to her home to give her a mild sedative "mixed with a soft drink such as Ribena". If this proved impossible, a consultant anaesthetist should be on hand so the woman could be forcibly injected with a faster-acting drug, ketamine.
The decision was praised by the learning disability charity, Mencap, which said it had never previously heard of a similar case. David Congdon, head of campaigns, praised the judge for making "a very difficult decision".
Sitting in the court of protection, the judge said that the woman, identified in the ruling only as PS, lacked sufficient capacity to make decisions about her own health. The case was brought by an unnamed NHS foundation trust, whose doctors believe PS will die if she does not have an operation to remove her ovaries and fallopian tubes. Evidence presented to Wall said PS was diagnosed last year with uterine cancer, which was slow growing but would, without surgery, ultimately spread and kill her.
Attempts to look more closely at the tumour using an MRI scan proved impossible as PS has both a phobia of hospitals and needles and is also claustrophobic, meaning she cannot lie still for a scan. After she refused to attend hospital several times, "the clinical team treating her has reluctantly come to the conclusion that special arrangements will need to be put in place both to ensure that she has the operation and that she remains in hospital for her post-operative recovery", the judgment said. While "every effort" would be made to avoid forcibly sedating PS, this as seen as a necessary back-up plan, the judge said. After the operation, she will remain drugged to make sure she does not flee.
The judge added: "However, it might be necessary to use force as a last resort to ensure that she returned to her hospital bed. She would, moreover, be closely monitored by nursing staff." The evidence he had been given "clearly establishes that it is in the best interests of PS" to undergo the operation, Wall ruled, and that there was a need to allow forcible sedation. The judgment, with identities obscured, was being delivered in open court, he added, in part "to assist others who may be faced with a similar dilemma".
David Congdon, head of campaigns at Mencap, praised the judge for his thoughtfulness in making "a very difficult decision". He said: "Our starting point is that someone with learning difficulties has as much right as anyone to refuse treatment. But in this case, because she does not realise the consequences of her actions it's right the Mental Capacity Act is invoked. I don't say that lightly, because it is a pretty dramatic step for the state to impose treatment on someone. The alternative would have been to not give her treatment because she refused it. That's something we've seen happen before in such cases and it would have been too easy."