Re L (an Adult: Non-consensual Treatment)
| Jurisdiction | England & Wales |
| Judgment Date | 1997 |
| Date | 1997 |
| Court | Family Division |
KIRKWOOD, J
Medical treatment – adult patient – patient in labour – consultant advising delivery by Caesarian section – patient agreeing but having a needle phobia – injection by needle necessary for anaesthetic – whether patient of relevant mental competence to weigh treatment information.
The patient was a healthy young woman in her 20s. She was about to give birth to a baby after a full term pregnancy. After some eight hours of labour during which the cervix did not dilate, the consultant obstetrician reached the view that without intervention the baby would die. The patient was keen to have the baby. The possibility of acceleration of labour by means of Syntocinon drip was discussed with her but she had an extreme phobia about needles and was unable to consent to that procedure. When asked, she agreed in principle to delivery by Caesarian section but was unable to consent to anaesthesia by injection. She consented to anaesthesia by gas inhalation but the consultant anaesthetist was unwilling to take that course because of the risk of gastric inhalation and the consequent risk of the patient's death.
An application was made on behalf of the relevant NHS Trust for a declaration as to the lawfulness of (a) the insertion of needles for the purpose of anaesthesia and intravenous infusion and (b) the performance of an emergency Caesarian operation.
Held – granting the application: A mentally competent patient had an absolute right to refuse treatment, and treatment of an unconscious patient which was not contrary to the known previously expressed decision of the patient was lawful if necessary to save the life or prevent a deterioration in the physical or mental health of the patient. However, a patient lacked the relevant competence to make treatment decisions if he or she was incapable of comprehending and retaining treatment information, believing such information, and weighing such information in the balance to
made a choice (the "Re C test": Re C (An Adult Refusal of Treatment)[1994] 2 FCR 151 at p 156E). In the present case the patient wished to be safely delivered of her unborn child and consented to any medical procedure except punctuation of her skin with a needle whilst she was conscious. This was an extreme phobia which amounted to an involuntary compulsion that disabled the patient from weighing treatment information in the balance to make a choice. Thus, in this instance, the patient lacked the relevant mental competence to make the treatment decision. The procedure of anaesthetising the patient by means of an injection followed by an emergency Caesarian operation was in the...
To continue reading
Request your trial
-
Re MB (an Adult: Medical Treatment)
...Jefferson v Griffin Spalding County Hospital Authority (1981) 274 SE 2d 457 (USA). L (An Adult: Non-consensual Treatment), Re[1997] 1 FCR 609. Madyyun, Re (1986) 573 A 2d 1259n (USA). Norfolk and Norwich Health Care NHS Trust v W[1997] 1 FCR 269. Open Door and Dublin Well Woman v Ireland [1......
-
Court‐Authorised Caesarean Sections — The End of a Trend?
...of Sheffield.1 (1998) 3 All ER 673.2Re S (Adult: Refusal of Treatment) [1992] Fam 123.3 See Re L (An Adult: Non-consensual Treatment) [1997] 1 FCR 609; Norfolk and Norwich Healthcare(NHS) Trust vW[1997] 1 FCR 269; Rochdale Healthcare (NHS) Trust vC[1997] 1 FCR 274;Tameside and Glossop Acute......