Nottinghamshire Healthcare NHS Trust v RC
2014
COURT OF PROTECTION
United Kingdom
CORAM
- MR JUSTICE HOLMAN
Areas of Law
- Health Law
- Human Rights Law
- Civil Procedure
2014
COURT OF PROTECTION
United Kingdom
CORAM
AI Generated Summary
This urgent, public application by an NHS Trust involved a 23-year-old male with a severe personality disorder, who, after adopting the Jehovah's Witness faith, signed an advance decision refusing blood transfusions despite life-threatening self-harming behavior. The High Court addressed the validity of the advance decision under the Mental Capacity Act 2005 and its potential conflict with the Mental Health Act 1983, particularly regarding life-saving treatment without consent. The court declared the advance decision valid but reserved judgment on overriding it, scheduling a further hearing.
Judgment
Mr Justice Mostyn :
RC is aged 23. He is the child of parents who practise the faith of the Jehovah’s Witnesses, but he was not baptised as such. At aged 4 he was taken into care. He was not brought up as a Jehovah’s Witness. He has a long history of repeated self-harming conduct which has extended to self-strangulation and other self-injury such as burning himself, self-laceration and head-butting. He has been diagnosed as suffering from both antisocial and emotionally unstable personality disorders. He has also suffered thromboses for which he is prescribed the anti-coagulant warfarin.
RC was first admitted to a psychiatric hospital in 2006, when aged 15. In 2012 he was convicted of a serious sexual assault and sentenced to 5 years imprisonment. In August 2013, while in prison, he embraced the religion of the Jehovah’s Witnesses, although he has not yet been baptised into that faith and the conversion procedure would be lengthy.
As is well-known, for doctrinal reasons Jehovah’s Witnesses will refuse a blood transfusion as part of medical treatment. This is a central article of faith and will be adhered to even if death eventuates. It derives from an interpretation of Genesis 9:4; Leviticus 17:10, 14; Deuteronomy 12:23; and Acts 15:28, 29, all of which prohibit the eating of blood.
On 1 February 2014 when in prison RC badly slashed his brachial artery (the major blood vessel of the upper arm) at the crook of his elbow. When in hospital he refused a blood transfusion although no harm resulted from that decision. On 12 March 2014 he was admitted to a secure psychiatric hospital. On a number of occasions he attempted to reopen the wound and was placed in a restraint belt to prevent him from doing so.
On 4 April 2014 RC signed an advance decision under sections 24 and 26 of the Mental Capacity Act 2005 (“MCA”). As I explain below, this was properly witnessed. It provided that no transfusions of blood or primary blood components should be administered to him in any circumstances, even if his life was at risk. Provided that he was of capacity when he made it, this decision has the same effect as if the decision was made when the proposed treatment is to be carried out.
On 9 April 2014 these proceedings were commenced. The applicant NHS trust seeks:
Pursuant to the MCA, declarations by the Court of Protection as to RC’s capacity:
to refuse blood products, and
to self-lacerate.
Again pursuant to the MCA, a declaration by the Court of Protectio