Urgent surgery on depressed patient ‘should be carried out’

Court of Protection

An urgent operation should be carried out an a depressive patient despite her objections, the Court of Protection has ruled.

In HN (Out of Hours Application) the woman in question suffered from depression and a mild psychosis. As a result she was detained in a specialist hospital in the Midlands by her local NHS Trust. Her detention was authorised under section 3 of the Mental Health Act 1983.

Early last month ‘HN’ made tried to kill herself, sustaining a number of injuries . Although she refused medical treatment, all but the most serious of her injuries begun to heal naturally. The most severe, a damaged shoulder, would need specialist surgery doctors concluded.

Then the fractured main bone in the upper part of her injured arm (her humerus) unexpectedly moved out of place and began to protrude through the skin. HN’s surgeon was very concerned about the possibility of infection and blood poisoning and believed surgical intervention was urgent.

If an infection did spread, the reconstructive surgery would become riskier and more seriously, her arm and part of her shoulder might need to be amputated, leaving her severely disabled. An infection could even be life-threatening.

As the doctors in charge of her case believed HN was likely to refuse the urgent operation required, they applied for permission to proceed without her consent, doing so via an application made out of normal court hours. The surgeon planned to carry out the surgery the very next morning.

Prior to the application, the surgeon and an anaesthetist assed HN’s ‘capacity’ – her ability to make rational decisions about her own welfare. They explained the planned operation to the patient, concluding that while she should could understand the information they presented, she was unable to make a meaningful decision on the basis of this. She did not ask questions and could not explain her thinking.

The surgeon, referred to as ‘Mr S’, consulted three other doctors and a senior nurse and they all agreed that the surgery should proceed.

The NHS Trust acknowledged that the operation would constitute a ‘deprivation of liberty’ – a limitation of HN’s personal autonomy – which exceeded that inherent in her existing detention under the Mental Health Act.

Court of Protection Mr Justice Peter Jackson considered the written evidence presented and concluded that there was no need to prolong proceedings or insist on oral witnesses. The surgery was clearly in her best interests.

In a later written ruling her reported:

“The Trust has subsequently confirmed that the operation took place the following morning, and had gone as expected with no problems. HN went to theatre very passively, with no restraint or sedation. She is currently on intravenous antibiotics, as it appears that the fracture has indeed become infected.”

The full judgement can be read here.

Image by kaolin fire via Flickr under a Creative Commons licence

Stowe Family Law Web Team

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