Re M B (Caesarian section)

JurisdictionEngland & Wales
CourtCourt of Appeal (Civil Division)
Judgment Date26 March 1997
Neutral Citation[1997] EWCA Civ 3093
Date26 March 1997

Court of Appeal

Before Lord Justice Butler-Sloss, Lord Justice Saville and Lord Justice Ward

In re M B (Caesarian section)

Medical treatment - phobia against needles resulting in incompetence - non-consensual treatment

Phobia caused incompetence

A woman who needed and desired to have a Caesarian section but whose fear of needles caused her to panic in the operating theatre and refuse to have the anaesthetic and undergo the operation was, at the moment of panic, suffering from a mental impairment which made her temporarily incompetent and, as the Caesarian section was in her best interests, it was appropriate for the court to order that it would be lawful for doctors to operate on her without her consent.

The Court of Appeal so held in giving reasons for dismissing on February 18 an appeal by the woman against a decision of Mr Justice Hollis to grant a declaration that it would be lawful for the operation to take place.

Mr Robert Francis, QC, for the woman; Mr John Grace, QC, for the hospital; Mr Michael Hinchliffe as amicus curiae.

LORD JUSTICE BUTLER-SLOSS, giving the judgment of the court, said that in general it was a criminal and tortious assault to perform physically invasive medical treatment, however minimal the invasion might be, without the patient's consent.

A mentally competent patient had an absolute right to refuse consent to medical treatment for any reason, rational or irrational, or for no reason at all even where that decision might lead to his or her death.

Medical treatment could be undertaken in an emergency even if, through lack of capacity, no consent had been competently given, provided the treatment was a necessity and did no more than was reasonably required in the best interests of the patient.

All the recent decisions in Caesarian section cases arose in circumstances of urgency or extreme urgency. The evidence was in general limited in scope and the mother was not always represented as a party. With one exception the court had decided in all the cases that the mother did not have the capacity to make the decision.

In such extremely worrying situations it was important to keep in mind the basic principles laid down in the authorities and the court should approach the crucial question of competence bearing the following considerations in mind:

1 Every person was presumed to have the capacity to consent to or to refuse medical treatment unless and until that presumption was rebutted.

2 A competent woman who had the...

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