A new case on necessity?

This case is now available online. It is called Great Western Hospitals NHS Foundation Trust v. AA, BB, CC, DD [2014] EWHC 132 (Fam). It makes for very interesting reading indeed. It explicitly uses a best interests analysis, explains the effect on criminal and tort liability of the declaratory relief granted, and excludes consideration of the interests of the foetus.



In this case the court used its inherent jurisdiction to permit the doctors to perform a caesarean section on a 25 year old woman (AA) with a history of affective bipolar disorder and substance abuse. Late into her pregnancy, she became symptomatic again, and began suffering from hypomania and puerperal psychosis. At this point, she had a suspected seizure and was admitted to hospital, where it was found that her membranes had ruptured. This gave rise to a serious risk of infection to herself and to the foetus. The doctors wanted to induce pregnancy to prevent infection, but in her agitated and disorientated state, AA refused to cooperate with most of her treatment, and even, at one stage, tried to jump out of a window, saying that she wanted to go to heaven. Because of AA's advanced state of pregnancy, she could not be administered the anti-psychotics needed to address her mental condition. This meant that using drugs to induce labour was ruled out, since it was considered unlikely that AA would co-operate with the extended period of treatment and monitoring required for such a course of action. The only viable option was an elective caesarean section, but AA was unwilling to consent, because she believed that the baby could only be born on her own birthday (i.e. the date she had been told was the due date). AA's partner and parents were keen for the c-section to be performed, and by all accounts AA had welcomed the pregnancy as well.



The High Court exercised its inherent jurisdiction to grant permission to the doctors to administer general anaesthesia to AA, and to perform the c-section on her. In doing so, it ruled that AA lacked the capacity to make decisions in relation to the serious medical treatment at issue, and that therefore it was granting permission for the medical treatment in AA's best interests. The interests of the foetus was noted, but not deemed to be a relevant consideration in the best interests analysis. In this, the court would seem to be consistent with the ruling in St. George’s Healthcare NHS Trust v. S [1998] 3 All ER 673. The court also expressly stated that the effect of its declaration was to provide the Hospital with a defence to any allegation of criminal or tortious liability for trespass to the person.