Re T (adult: refusal of medical treatment) [1992] 4 All ER 649 (CA)

Consent – capacity – refusal – medical treatment – undue influence

T was injured in a car accident when she was 34 weeks pregnant. After speaking to her mother who was a Jehovah’s Witness, T repeatedly refused a blood transfusion, despite this being seen as essential to save her life. T said that although she was no longer a Jehovah’s Witness herself, she still retained some of the beliefs.

Overriding T’s refusal, the Court said that although prima facie every adult had the right and capacity to decide whether he would accept medical treatment, even if a refusal might risk permanent injury to his health or even lead to premature death, and regardless of whether the reasons for the refusal were rational or irrational, unknown or even non-existent, if a patient’s capacity to make a decision had been overborne by the undue influence of others, it was the duty of the doctors to treat him in whatever way they considered, in the exercise of their clinical judgement, to be in his best interests.

The Court also gave the following guidance on consent:

 

the next of kin of a patient who is physically and mentally capable of exercising a choice but who is not in the position to make such a decision because, for example, he is unconscious has no legal right to consent or to refuse consent to medical treatment on behalf of the patient, although consulting with the next of kin will generally be good practice;

whilst a failure to give the patient appropriately full information as to the nature of the treatment and the likely risks might lead to a claim in negligence, it did not of itself vitiate a consent or refusal;

misinforming a patient, whether innocently or not, and withholding information which is expressly or impliedly sought by the patient may well vitiate either a consent or a refusal;

If, in a potentially life-threatening situation or one in which irreparable damage to the patient’s health can be anticipated, doctors or hospital authorities are faced with a refusal of an adult patient to accept essential treatment and they have real doubts as to the validity of that refusal, they should both in the public and the patient’s interest at once seek a declaration from the courts as to the lawfulness of the proposed treatment and it should not be left to the patient’s family to take action.