A woman who was allowed to refuse medical treatment, after having been found to have capacity to do so, has died.

The woman, known only as C was the subject of court proceedings in the Court of Protection. It concerned an application brought by Kings College Hospital NHS Foundation Trust to seek declarations that it was in the woman’s best interests to receive renal dialysis to treat an acute injury to her kidneys. The injury to the woman’s kidneys was caused by a failed attempt at suicide.

The issue for the court to determine was whether C had the capacity to be able to refuse treatment. If she was found to have the capacity to refuse treatment, then the Court of Protection had no powers to make any declarations in her best interests and medical professionals cannot treat an adult without their consent. The Court of Protection can only make decisions on behalf of adults who are found to lack capacity to make the relevant decision.

If she was found to lack the capacity, the judge was still required to decide whether treatment was in her best interests, looking at a variety of factors including C’s own wishes and feelings.

The judgment sets out in detail that C was not someone who could ever be described as ‘normal’. He heard evidence from her family that she “led a life characterised by impulsive and self-centred decision making without guilt or regret.” This included four marriages and numerous affairs. Her life centred around her looks, money and material objects. In C’s own words, she wanted to live a life that ‘sparkles’.

It is also notable that having been diagnosed with breast cancer in December 2014, she refused to take the medication prescribed because it made her fat and she was concerned that any operation would affect her ability to wear a bikini.

The issue of whether a person has capacity can often be complex and controversial. There were three psychiatrists instructed to assess her capacity and they disagreed. The law states that a person should not be assessed as lacking capacity because they make an unwise decision. However, an inability to weigh up the pros and cons of a decision (which may lead them to making an unwise decision) is part of the test of establishing a lack of capacity.

Helen Dandridge, solicitor in Ridley & Hall’s Court of Protection team, commented, “It is clear that the judge here carefully considered all of the evidence available to him, both from experts and from family members in reaching his decision. C’s personal life, in particular that she had made previous past decisions that others may perceive to have been ‘unwise’ was an important factor to consider because capacity is issue specific and person specific.”

The decision of the judge was that C did have the capacity to refuse medical treatment and therefore he could not make any declarations on her behalf relating to medical treatment.

Helen went on to say, “We will never know what decision the judge would have reached in C’s best interests if had he found she lacked capacity. However, her clear wishes and feelings, and the fact that she had previously refused treatment for other medical conditions would have been important factors to consider under the ‘best interest checklist’.”

It has since been reported by one of C’s daughters that she died 15 days after the judgment was issued.

Ridley & Hall’s Court of Protection team have expertise in advising on a range of disputes concerning people who may lack capacity. We have the experience to advise on issues of capacity and whether capacity assessments can be challenged. If you require advice or assistance please call us today on 01484 538421.

The full judgment can be found here.