Legal Updates

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 death.

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.

Stephen Cragg

Doughty Street Chambers