In a ruling which tackled important issues relating to mental health and the capacity of individuals to make choices about their medical care, the High Court has cloaked doctors with the authority that they required to perform a Caesarean section on an expectant mother who suffers from acute bipolar disorder.
The woman was 38 weeks pregnant with a ‘wanted child’ and had a history of acute psychiatric problems which required a battery of anti-psychotic medication. She had presented at a hospital in a highly disorientated state with her membranes ruptured. She had been detained under the Mental Health Act 1983 but remained highly agitated and largely un-cooperative with almost every aspect of her obstetric care.
The NHS Trust responsible for her care applied to the Court for authorisation to deliver the baby by Caesarean section under general anaesthetic. Clinicians were unanimous in their view that, although induction of natural labour would be the ordinary course in such a case, a Caesarean delivery represented ‘by some distance the safest option’ for both mother and baby in the particular circumstances.
In granting the Trust’s application, the Court noted that, whilst the woman was not yet in labour, the rupture of her membranes gave rise to a risk of serious infection and that a swift delivery was therefore required. Given the woman’s state of extreme anxiety, fatigue and distress, she could not be expected to co-operate with the strict regime of monitoring required in the induction of a natural birth.
It was clear that the woman currently lacked the capacity to make crucial decisions relating to her care or to consent to the Caesarean delivery. A decision to compel medical procedures on those who do not have capacity to consent was an onerous matter and the Court observed that its role was to ‘cloak the clinicians’ decision’ with legal authority and to provide them with a defence to any potential allegations of criminal or tortious liability for trespass to the person.