Collins, Pathfinder Mental Health Services NHS Trust and St George’s Healthcare Trust, ex p S [1998] 3 All ER 673 (CA)

Medical treatment – capacity to consent – right to refuse treatment – mental health

Having regard to the right of an individual to autonomy and self-determination, an adult of sound mind was entitled to refuse medical treatment, even when his or her own life depended on receiving such treatment. In the case of a pregnant woman, that right was not diminished merely because her decision to exercise it might appear morally repugnant. In the instant case, the declaration sought (ie the delivery of the patient’s baby by Caesarean section) involved the removal of the baby from S’s body under physical compulsion and that removal amounted to trespass.

The Mental Health Act 1983 could not be used to detain an individual against his or her will because his or her thinking process was unusual, even apparently bizarre and irrational, and contrary to the views of the overwhelming majority of the community at large. The Act could only be used to justify detention for mental disorder if the case fell within the prescribed conditions. Moreover, a person detained under the Act for mental disorder could not be forced into medical procedures unconnected with his or her mental condition unless his or her capacity to consent to such treatment was diminished.

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