In Re W (adult: refusal of treatment) (24 April 2002) the court
considered an application by a high security prisoner (“W”) under
the inherent jurisdiction of the high court for a declaration that
he had mental capacity and as such had the right to choose whether
or not to accept medical treatment.
The circumstances of W’s case was that he had what doctors
had decided was an untreatable psychopathic disorder, and therefore
the doctors had returned him from a special hospital to prison. W
undertook a campaign designed to have himself returned to the
hospital, primarily by creating a wound on his leg and then
continually re-opening the wound an introducing foreign objects
into it. These actions carried the high risk of infection, serious
injury and possibly death.
However, three psychiatrists were of the view that W had mental
capacity to decide for himself whether he wished to have medical
treatment. He understood that, by refusing to accept treatment, the
leg wound and possible ensuing septicaemia would lead to his
The court decided that if W had capacity he had the absolute
right to refuse to consent to medical treatment for any reason,
rational or irrational or for no reason at all, even where the
decision could lead to his or her own death.
Comment: This case raises the importance of establishing that a
person lacks capacity before any treatment is provided to them
against their will. The judgement, and previous similar cases, will
be of relevance to nursing and residential homes where residents
are reluctant to receive treatment or to reside at the home. Unless
the resident lacks capacity (ie is unable to process and understand
information about their situation) then there is nothing that can
be done to force a person to accept treatment or services that they
do not not wish to receive.
If in doubt then a local authority or other relative would be
able to apply to the high court to seek a ruling as to whether a
person lacked capacity, and if they do, what treatment or services
it would be in their best interests to receive.
Doughty Street Chambers