Serious Medical Treatment

A Mental Health Trust, an Acute Trust and a Council v DD and BC [2015] EWCOP 4

This has been described as the most important case in the history of the Court of Protection; involving a decision as to whether a 36 year old woman should be subjected to a caesarean section and then sterilised against her wishes. It raised the possibility of public authorities being accused of social engineering, or reckless neglect if she died because of her refusal to co-operate. The case threw up exceptionally difficult practical and legal issues, including establishing incapacity, ensuring that her voice was heard at court and that the court was able to make a decision with no room for ambivalence. A key part of the management of the case was to secure the continuous co-operation between different statutory agencies while dealing with the tenacious scrutiny from the Official Solicitor acting on behalf of the patient. The court noted the ethical, legal and medical issues arising were self-evidently of the utmost gravity. It concluded that relief sought was “extraordinary” but necessary. We supported all three public authorities throughout these complex proceedings – from initial advice, inputting into professional multi-agency meetings, preparing the application, briefing counsel and producing over 5 lever-arches of persuasive written evidence (enabling the Official Solicitor to change his position, from initial opposition to supporting the proposal as being in her best interests).

NHS Trust v FG [2014] EWCOP 30

In which we acted for one of the NHS Trusts in the case involving precedent setting guidance from the Court of Protection on when obstetric cases should be subject to a Court of Protection application. The Law Society notes: "This judgment is important because Keehan J confirmed that the acid test applies in the acute setting."

Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67

We acted, on a pro-bono basis, for the Intensive Care Society, in this leading Supreme Court judgement on withdrawing and withholding life sustaining treatment.

Unreported Judgement – Urological Treatment

This case involved a complex decision about whether a patient with a serious medical condition and a mental disorder should be subjected to treatment against his wishes; for diagnosis, investigation, treatment and management of P's urological, nephrological and prostatic condition. The case required careful, detailed preparation to ensure that the patient's rights were properly respected and the professionalism of the Trust clinicians was appropriately highlighted. Roderic Wood J stated in open Court that the application had been prepared “immaculately” and that he had “never seen an application prepared to this standard”. He continued "P is a very fortunate man indeed. The way this case has been dealt with by the doctors and those representing them, has meant that I haven’t had to go through a lot of the issues and details I ordinarily have to in these cases."

Unreported Judgement – End of Life Care

We acted for this Trust in a complex disputed end of life care case where an elderly patient's daughter refused to accept that her father should have treatment withheld. The clinicians in this case required considerable support and advice to ensure they felt protected in an environment that had the potential to become hostile. We advised on the legality of proposed care plans and management of the patient's relatives' expectations and behaviour, provided guidance in decision-making processes, supported clinicians in the preparation of witness evidence, drafted the application and prepared appropriate documents such as the care plan. We supported witnesses at the hearing and provided dynamic advice in parallel to the patient's condition and other parties' approaches. Ultimately, the decision reached was accepted and implemented but more importantly, the stress of a difficult, emotionally charged hearing did not turn into an inquisition and the Trust staff were able to discharge their duty as part of a public authority acting lawfully and appropriately.