Court of Protection rules on urgent Caesarean section for mentally ill patient

Court of Protection rules on urgent Caesarean section for mentally ill patient

The Court of Protection has delivered a crucial ruling concerning the best interests of a pregnant woman, SC, who is currently experiencing significant mental health challenges. The case, heard by Mr Justice Cusworth, involved an application by the Mid Yorkshire Teaching NHS Trust for a planned Caesarean section to be performed on SC, who is detained under the Mental Health Act 2005.

SC, a 37-year-old woman, has a complex obstetric and mental health history. She has previously undergone two emergency Caesarean sections and has been diagnosed with mania with psychotic symptoms. The urgency of the case arose from medical concerns about static foetal growth and the risk of spontaneous labour, which necessitated an earlier delivery than initially planned.

The court heard that SC's mental health had deteriorated, leading to delusional beliefs about her pregnancy. She believed she was carrying multiple babies and expressed a strong desire for a natural birth, despite medical advice to the contrary. The Official Solicitor, acting as SC's litigation friend, highlighted SC's reluctance to engage with obstetric care and her suspicion of medical staff.

Mr Justice Cusworth considered the legal framework under the Mental Capacity Act 2005, which requires the court to assess whether SC had the capacity to make decisions regarding her delivery. The court found that SC lacked capacity due to her mental health condition, which impaired her ability to understand and weigh the relevant information.

The court's decision was guided by the principles of best interests, taking into account both medical and non-medical factors. The medical evidence presented by consultant obstetricians and psychiatrists indicated significant risks to both SC and her unborn child if the Caesarean section was delayed. These risks included uterine rupture, placental insufficiency, and potential harm to SC's mental health.

Despite SC's expressed wishes against a Caesarean section, the court determined that proceeding with the planned delivery was in her best interests. The judgment emphasised the need to ensure the safest outcome for SC and her unborn child, recognising the potential for further trauma if SC's delusional beliefs were not addressed.

The court also acknowledged the broader implications of the decision, noting the potential impact on SC's mental health following the birth, particularly given the local authority's plans to seek the removal of the child. The ruling underscored the importance of balancing SC's autonomy with the need to protect her physical and mental well-being.

Learn More

For more information on medical negligence, see BeCivil's guide to Medical Negligence.