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|Guy's and St Thomas' NHS Foundation Trust v R (2020) EWCOP 4||
Contingent/anticipatory declarations - MCA/inherent jurisdiction - Caesarean section
R had capacity to make decisions as to her ante-natal and obstetric care but there was a risk that she would lose capacity during labour and refuse a Caesarean section. (1) MCA 2005 s16 (Powers to make decisions and appoint deputies: general) applies only to those who currently lack capacity. (2) MCA 2005 s15 (Power to make declarations) is not so limited and so can authorise contingent declarations. (3) Deprivation of liberty cannot be authorised by s15 but the inherent jurisdiction may be utilised to fill that lacuna which would otherwise render the s15 power nugatory.
|NHS Cumbria CCG v Rushton (2018) EWCOP 41||
Withdrawal of CANH; advance decision
"This is an application regarding the proposed withdrawal of clinically assisted nutrition and hydration in respect of Mrs Jillian Rushton, who is now 85 years of age. Since sustaining a traumatic head injury in December 2015, Mrs Rushton has suffered from a prolonged period of disorder of consciousness. Insofar as a label is relevant, the consensus of medical opinion, in respect of which there is no dissent at all, is that she is in a persistent vegetative state (PVS). In their recent guidance, ‘Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent’, the Royal College of Physicians and the British Medical Association have noted that the importance of obtaining a precise and definitive diagnosis has reduced. It is recognised by the Courts and clinicians that drawing a firm distinction between vegetative state and minimally conscious state is frequently both artificial and unnecessary. In practice, when assessing best interests, information about the patient’s current condition and prognosis for functional recovery and the level of confidence with which these can be evaluated is invariably of greater importance than a precise diagnosis. ... It perhaps requires to be said, though in my view it should be regarded as axiomatic, that the medical profession must give these advanced decisions the utmost care, attention and scrutiny. I am confident the profession does but I regret to say that I do not think sufficient care and scrutiny took place here. The lesson is an obvious one and needs no amplification. Where advanced decisions have been drawn up and placed with GP records there is an onerous burden on the GP to ensure, wherever possible, that they are made available to clinicians in hospital. By this I mean a copy of the decision should be made available and placed within the hospital records with the objective that the document should follow the patient. It need hardly be said that it will rarely, if ever, be sufficient to summarise an advance decision in a telephone conversation. ... The family have ... made it clear to me that she would not have regarded her present situation as tolerable. Whilst I have no doubt that she would understand the commitment of her son, Tim and his profound resistance to letting her go, I have equally no doubt that she would want to be let go and I have no hesitation in concluding that it is my responsibility to respect this."
|Southend-On-Sea Borough Council v Meyers (2019) EWHC 399 (Fam)||
Inherent jurisdiction prevents elderly man from living with son
"The essence of his vulnerability is, in fact, his entirely dysfunctional relationship with his son ... Mr Meyers, I am satisfied, is entirely capable of and has the capacity ... for determining where he wishes to reside and with whom. ... I instinctively recoil from intervening in the decision making of a capacitious adult ... Here Mr Meyers' life requires to be protected and I consider that, ultimately, the State has an obligation to do so. Additionally, it is important to recognise that the treatment of Mr Meyers has not merely been neglectful but abusive and corrosive of his dignity. To the extent that the Court's decision encroaches on Mr Meyers' personal autonomy it is, I believe, a justified and proportionate intervention. The preservation of a human life will always weigh heavily when evaluating issues of this kind. ... The objective here ... is that Mr Meyers be prevented from living with his son, either in the bungalow or in alternative accommodation. I do not compel him to reside in any other place or otherwise limit with whom he should live. ... The impact of the Court's intervention is to limit Mr Meyers's accommodation options but it does not deprive of his physical liberty which is the essence of the right guaranteed by Article 5. ... It is also necessary to restrict the extent of Mr Meyers's contact with his son in order to keep him safe. ... To the extent that this interferes with his Article 8 rights it is, again as I have indicated above, a necessary and proportionate intervention. ... The ideal solution here, it seems to me, would be for Mr Meyers to return to his bungalow with a suitable package of support, his son having been excluded from the property."