Re JT (adult: refusal of medical treatment)
| Jurisdiction | England & Wales |
| Judgment Date | 08 January 1997 |
| Court | Family Division |
WALL J
Medical treatment – Adult patient suffering mental disability and refusing treatment for renal failure – Hospital seeking declaration lawful to abide by her refusal – Whether patient having capacity to refuse treatment – Whether declaration required.
The 25-year-old female patient, who was resident in a hospital suffering from mental disability, developed renal failure. She was then admitted to a clinic for treatment and, as a result of her behaviour, detained under the Mental Health Act 1983. Thereafter several unsuccessful attempts were made to give the patient renal dialysis, and she eventually, and consistently, refused further medical treatment, expressing instead her desire to die. Since the doctors were in agreement that there was no other form of suitable treatment for her, the NHS Trusts involved issued an originating summons seeking declarations that the patient was capable of refusing medical treatment and that in those circumstances it was lawful for the two trusts or their servants or agents not to perform renal dialysis on her.
Held – Where, notwithstanding mental illness, a patient was capable of understanding and retaining treatment information, of believing such information and of weighing such information in the balance to make a choice, he was competent to make treatment decisions which were effectively determinative of the case. Accordingly since in those circumstances to impose treatment on such a patient against his will would be a criminal and tortious assault, it was unnecessary for the court to grant a declaration that the withholding of such treatment was lawful. It followed that the originating summons would be dismissed.
Per curiam It will be different if a hospital is seeking a declaration rendering lawful that which would otherwise be unlawful; for example physical restraint of the patient in order to administer treatment.
Case referred to in judgmentC (an adult: refusal of treatment), Re[1994] 2 FCR 151, [1994] 1 All ER 819, [1994] 1 WLR 290.
Originating summonsThe plaintiffs, two NHS Trusts involved in the treatment of the patient, issued an originating summons seeking declarations that the patient was capable of refusing medical treatment and that in those circumstances it was lawful for the two trusts or their servants or agents not to perform renal dialysis on her. The case was heard and judgment was given in chambers. The case is reported with permission of Wall J. The facts are set out in the judgment.
Adrian Whitfield QC and Sean Wilken for the applicants.
Huw Lloyd for the respondent.
WALL J.This is an application for declaratory relief sought by the two NHS Trusts in relation to a young woman called T.
The declarations sought effectively are these. Firstly, that T is capable of refusing and/or has the capacity to refuse medical treatment. Secondly, that it is lawful for the two trusts and/or their servants or agents to abide by her refusal, and not perform renal dialysis on her.
It is a very sad case. T is some 25 years old. She suffers from mental disability, and I have heard evidence from the consultant psychiatrist treating her as well as from a second psychiatrist who saw her for the purpose of assessing her mental capacity to agree to or withhold agreement to treatment.
She was admitted to the clinic on 26 June 1996, initially as an informal patient. She had earlier been resident at a hospital where it was found that she had developed renal failure. Consequently, when she was...
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