Judge rules surgery is in the best interests of a woman with ovarian cancer
A judge has ruled in the case of a schizophrenic cancer patient that she must undergo surgery against her will as she did not have the mental capacity to make a decision about her treatment.
The woman who I will refer to as ‘P’ had paranoid schizophrenia. She was in her 30s when she received a diagnosis of ovarian cancer. P was admitted to hospital for a hysterectomy and she refused surgical treatment. P’s refusals of treatment lead the Trust responsible for her care to make an application to the Court of Protection.
The Court of Protection, amongst other matters, considers health and welfare issues relating to vulnerable people who may not have the mental capacity to make decisions in relation to their treatment.
The judge was required to make two decisions:
- Whether P had the mental capacity to consent to or refuse medical treatment for ovarian cancer
- Is it in her best interests to undergo medical treatment?
The judge ruled that P lacked capacity to make decisions in relation to her treatment and also it would be in her best interests to have a hysterectomy.
If P were to undergo the surgery, she would not be able to have children. However, if she did not have the surgery, doctors involved in her treatment said that P would cease to be a candidate for surgery within weeks and would more than likely die before the end of the year. Although P’s prognosis if she did have the surgery was uncertain, P had a chance of being cured and at least achieving a survival period of between three and five years.
The Judge was satisfied that P’s paranoid schizophrenia constitutes a disturbance in the functioning or the mind or brain. That disturbance was severe. In the circumstances, by reference to the test set out in the Mental Capacity Act 2005, the Judge said that they were satisfied on the evidence before the court that P lacks the capacity to consent or refuse medical treatment, specifically the hysterectomy.
The Judge considered whether there was a prospect of P recovering capacity to take the relevant decisions. The Judge stated:
The evidence of the doctor, and in particular the evidence regarding the duration and severity of P’s condition, her lack of insight into her illness, her erratic compliance with and poor response to anti-psychotic medication, her failure to engage with services when unwell, her recent relapse, the impact on her mental health of the previous attempt to perform the surgery and the acute manner in which her condition impacts on her thinking regarding the surgery, suggest strongly that P is unlikely, even with further treatment for her paranoid schizophrenia, to regain capacity to decide whether to consent to or refuse the treatment in question within the narrow timescale in which that surgery must be performed in order for it to benefit P and hence within the timescale of making the decision in question.
The Judge was satisfied that it was in P’s best interests to undergo the surgery recommended. The Judge stated:
The proposed treatment offers the chance of a significantly prolonged life-span and, perhaps, a cure and is consistent with preserving the sanctity of P’s life by administering life-sustaining treatment where responsible medical opinion is of the view that such treatment is in P’s best interests. Whilst P will lose the ability to have children, her likely prognosis without treatment precludes that in any event, in that without surgery the likelihood is that death will occur in a timescale much shorter than that required to carry a baby to term.
The Judge was satisfied that the chance of continued life outweighs the permanent loss of fertility.