Re S (Sterilisation: Patient's Best Interests)
| Jurisdiction | England & Wales |
| Judgment Date | 1999 |
| Date | 1999 |
| Year | 1999 |
| Court | Family Division |
Medical treatment – Adult – Sterilisation – Future risk of pregnancy – Whether court should authorise sterilisation.
X, who was 31 years old, was physically able but had severe mental retardation. For many years she had regularly attended an adult training centre every week day, enjoying physical contact with men and a close friendship with a male user. Her expressed interest in sexual relationships and desire to have a baby meant that, if not prevented, there was a real risk of her becoming pregnant. X had been fitted with an intrauterine coil and when it needed replacing, her parents, supported by the Official Solicitor, applied to the High Court for a declaration that an operation of sterilisation would be in X’s best interests and could lawfully be performed on her. The consultant psychiatrist instructed by the Official Solicitor reported that X was not capable of making her own decision about sterilisation.
Held – On an application to authorise the sterilisation of a young woman the court had to decide whether or not the proposed operation was in the woman’s best interests. In deciding that question regard had to be given to the degree of risk or likelihood of her having sexual intercourse, the risk of physical or psychological harm if she did become pregnant or gave birth to a child, and the range of possible alternative methods of contraception and associated risks and whether there was any acceptable but reversible or less invasive alternative to sterilisation. Applying those principles to the present case, there was a real risk that X would have a relationship with a sexual ingredient and might become pregnant, that any pregnancy was likely to be very frightening, bewildering and upsetting to her and would include the risk of delivery by Caesarean which would be no less invasive than sterilisation itself, and that since the only viable alternative was the insertion, under general anaesthetic, of three further intrauterine devices during X’s reproductive life with their attendant risks of infection which X might not report, it followed that the form of contraception most in X’s interests was permanent sterilisation. Accordingly, as the sterilisation would protect X from risk and also indirectly allow her to have more freedom, the declaration would be granted.
Cases referred to in judgmentF (mental patient: sterilisation), Re [1990] 2 AC 1; sub nom F v West Berkshire Health Authority (Mental Health Act Commission intervening) [1989] 2 All ER 545, [1989] 2 WLR 1025, HL.
S (adult: sterilisation), Re[1999] 1 FCR 277.
ApplicationThe parents of a 31-year-old woman, who suffered from severe mental retardation, applied to the High Court, supported by the Official Solicitor, for a declaration that an operation of sterilisation would be in the woman’s best interests and could be lawfully performed upon her. The case was heard and judgment was given in chambers. The case is reported with the permission of Holman J. The facts are set out in the judgment.
John Ker-Reid (instructed by Townsends) for the mother.
Claire Wills-Goldingham for the Official Solicitor.
HOLMAN J.X is now aged 31. When she was still very young her parents began to realise that she was not developing entirely normally, and it became apparent that her mental and intellectual development is considerably retarded. The aetiology has always been uncertain. In the words of her mother, X is—
‘physically able but quite severely mentally retarded. She has the symptoms of Downs Syndrome without the visual and physical effects. Her mental age is between four and six.’
By way of examples, her mother says:
‘She cannot handle money or read but can just write her name. She does not understand the real value of money, she can cross the road, she can dress herself and wash herself with prompting and supervision. She needs prompting to clean her teeth, she can catch a bus, can converse but will not talk to strangers. She can play games but does not recognise snap in the game of snap.’
It is clear from all the evidence, including medical evidence, that whatever its cause, the condition is incurable and lifelong. X’s parents, supported by their other daughter (who is...
To continue reading
Request your trial
- Tower Hamlets LBC v BB
-
R (B) v SS, Dr AC and the Secretary of State for Health
... ... on the basis only that the doctor considers it to be in his 'best interest'. The fact that the patient has capacity is a relevant ... that:- "I do not take the view that detained patients who have the capacity to decide for themselves can never be treated ... and inevitably override all other issues except where the interests of other people would be affected if the medication was not administered" ... the House of Lords in the case of In Re F (Mental Patient: Sterilisation) ( [1990] 2 AC 1 ) especially by Lord Brandon at 55E and 56D, by Lord Goff ... ...
-
Re M (Adult Patient) (Minimally Conscious State: Withdrawal of Treatment) [Court of Protection]
...who lacked capacity was for all practical purposes the same as the parens patriae jurisdiction: see e.g. dicta of Thorpe LJ in Re S (Adult Patient: Sterilisation) [2001] Fam [2000] 2 FLR 289 at 29–30 and 403 respectively, and of Munby J (as he then was) in A v A Health Authority and others;......
-
Re A (Medical Treatment: Male Sterilisation)
...Re [1989] 1 FLR 182. W (an adult: sterilization), Re [1993] 2 FCR 187, [1993] 1 FLR 381. X (adult patient: sterilisation), Re[1999] 3 FCR 426, [1998] 2 FLR Y (mental incapacity: bone marrow transplant), Re[1997] 2 FCR 172; sub nom Re Y (mental patient: bone marrow donation) [1997] Fam 110, ......