Re W (Adult: refusal of treatment) [2002] EWHC 901 (Fam)

Treatment – consent – refusal – capacity

W was a prisoner at a high-security prison serving a life sentence for murder. He suffered from a severe psychiatric disorder and after conviction was transferred to Broadmoor Hospital for assessment as to treatment in the hospital environment. He was found not to be amenable to treatment and discharged back to a high-security prison. On his return to prison, W began a campaign aimed at compelling the prison authorities to have him treated in a special hospital. He cut open his lower right leg, continually forcing various foreign objects into it to keep it open and turn it sceptic. W had resisted all attempts to close the wound, and had refused treatment for the resulting infection, including antibiotics. He had, however, accepted treatment for other non-lie threatening self-inflicted injuries.

The issue before the court was whether W had mental capacity to refuse medical treatment for the leg wound, any life-saving treatment that might in due course become necessary, and possibly resuscitation. The three psychiatrists who had interviewed him were of the view that W was not suffering from a mental illness, mental impairment or severe mental impairment but was suffering from a severe psychopathic disorder characterised by paranoid thinking and a loss of ability to accept responsibility for his own actions. That, however, according to all three psychiatrists, did not impair his mental capacity to understand, retain and weigh the information required to reach a decision about his state of health. He understood that, by refusing to accept treatment, the leg wound and any possible ensuing septicaemia would eventually lead to his death.

Reiterating the legal position that ‘every person’s body is inviolate and a mentally-competent patient had an 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, the judge held that the evidence that W had mental capacity was overwhelming. All three psychiatrists’ reports indicated that W was able to comprehend and retain information which was material to the decision, especially as to the likely consequences of having or not having the treatment in question and that W was able to use the information and to weigh it in the balance as part of the process of arriving at a decision. Accordingly, the court was satisfied that W had mental capacity to choose to refuse or accept treatment, and that he had mental capacity at this stage to refuse treatment and/or resuscitation in the future, even if at that stage he was not in a mental capacity to be able to make that decision.

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