LAW REPORT: 12 May 1998; Pregnant woman was entitled to refuse Caesarian

Regina v Collins and others, ex parte S; Court of Appeal (Lady Justice Butler-Sloss, Lord Justice Judge and Lord Justice Robert Walker) 7 May 1998

A PREGNANT woman was entitled to refuse medical treatment even though her own or her unborn child's life depended on it.

The Court of Appeal allowed an appeal against a declaration that St George's Healthcare NHS Trust might carry out investigations and treatment, including Caesarian section by general anaesthetic, on S, who was suffering from severe pre-eclampsia but who refused to consent to such treatment. The court also allowed S's applications for judicial review of decisions to admit her to and detain her at Springfield Hospital under section 2 of the Mental Health Act 1983; to transfer her to and detain and treat her at St George's Hospital; to make the application for a declaration; to undertake the medical procedures which culminated in the birth of her child; and to return her to and treat her at Springfield Hospital after the birth.

S had sought to register as a new patient at a local NHS practice. She was approximately 36 weeks pregnant, and had not sought ante-natal care. Pre-eclampsia was diagnosed and she was advised that she needed urgent treatment, including admission to hospital for an induced delivery. Without that treatment her health and life and those of her baby were in danger. She fully understood the potential risks but rejected the advice, wanting her baby to be born naturally.

S was seen by a social worker approved under the Mental Health Act 1983, and two doctors. The social worker applied under section 2 of the 1983 Act for S's admission to Springfield Hospital for "assessment", and the two doctors signed the necessary written recommendations. That evening S was admitted to Springfield Hospital against her will.

She was then transferred, again against her will, to St George's Hospital, and in view of her continuing adamant refusal to consent to treatment, an application was made ex parte on behalf of the hospital authority as a result of which Hogg J granted a declaration which dispensed with S's consent to treatment. That night she was delivered of a baby girl by Caesarian section.

Richard Gordon QC and Barbara Hewson (Leigh Day & Co) for S; Lord Lester of Herne Hill QC and Beverley Lang (Solicitor, Merton Borough Council) for Ms Collins; Philip Havers QC and Monica Carrs-Frisk (Bevan Ashford, Bristol) for Pathfinder Mental Health Services Trust and St George's Healthcare NHS Trust.

Lord Justice Judge said that even when his or her own life depended on receiving medical treatment, an adult of sound mind was entitled to refuse it. That reflected the autonomy of each individual and the right of self-determination.

While pregnancy increased the personal responsibilities of a woman it did not diminish her entitlement to decide whether or not to undergo medical treatment. An unborn child was not a separate person from its mother. Its need for medical assistance did not prevail over her rights. She was entitled not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depended on it.

The declaration in the present case had involved the removal of the baby from within the body of the mother under physical compulsion. That constituted an infringement of the mother's autonomy.

For the purposes of detention under section 2 of the 1983 Act, the detention must be related to or linked with mental disorder. On the basis of the material available to them the social worker and the doctors, both of whom had diagnosed depression, had been entitled to conclude that S was suffering from mental disorder, but those involved in the decision to apply for admission under section 2 had failed to maintain the distinction between S's urgent need of treatment arising from her pregnancy, and the separate question whether her mental disorder warranted her detention. The application was therefore unlawful.

Kate O'Hanlon, Barrister