Great Western Hospitals NHS Foundation Trust v AA

Abstract

Mental health – Admission of patient to hospital. The applicant NHS trust applied to the obtain a caesarean section delivery of the respondent’s baby against her will. The respondent was a patient detained under the Mental Health Act 1983. The Family division held that it would make an interim order to that effect given the likelihood of serious ill health if the operation did not proceed, the small risks of the general anaesthetic and the fact of a scar were very significantly outweighed by the advantages to both mother and unborn baby of proceeding in that way.

Summary

The judgment is available at: [2014] EWHC 166 (Fam)

The respondent, AA was born in 1988 and was therefore nearly 26 years old. She had bi-polar affective disorder, which was diagnosed at the age of 18. She had been prescribed various medicines but had, on occasions, discontinued her medication when she has perceived herself to be well. She was 38 weeks pregnant. Her partner, BB was the father. AA’s membranes ruptured at approximately 0830 on 26th January 2014 but she did not go into labour. She was admitted to hospital. AA had not been taking her medication. On admission to the hospital, it was noted that she had displayed extreme agitation for the previous 60 hours. She was confused, vague and disorientated. Due to her state, she was sectioned under s 5(2) of the Mental Health Act. She was subsequently detained pursuant to s 2 of the Act on 27th January 2014.

There were concerns as to the health of AA and her baby. There was a serious and significant increase in the risk of infection as a result of AA’s membranes having broken. In the normal situation, labour would have been induced. AA was not prepared to cooperate with the proposed induction of her baby and labour could not be induced without her co-operation. Ongoing physical restraint would be required which was not feasible. The only other alternative was a caesarean section. That would require a general anaesthetic, which would involve a significant deprivation of liberty and required authorisation. There might well have to be further restraint following the operation. The doctor dealing with AA was clear, however, that one or other course of action was necessary urgently to avoid the risk of infection which would have very serious consequences. Without co-operation, it would have to be a caesarean section.

The relevant NHS Trust applied to the court ex parte in respect of the matter, seeking that the caesarian section be authorised. The application was made exparte and AA was not represented.

The issue for determination was whether the likelihood of serious ill health if the operation did not proceed, the small risks of the general anaesthetic and the fact of a scar were outweighed by the advantages to both mother and unborn baby of a caesarean.

The court ruled:

In the circumstances, given the likelihood of serious ill health if the operation did not proceed, the small risks of the general anaesthetic and the fact of a scar were very significantly outweighed by the advantages to both mother and unborn baby of proceeding in that way. Further, both AA’s parents supported that course of action. BB also added his support. A final order would not however be made in such a serious matter late at night on a without notice basis without AA being represented. Nevertheless, an interim order would be made authorising the treatment if AA either went into labour but, for whatever reason, required a caesarean section or she began to show signs of infection. In such circumstances, the advantages of the treatment significantly outweighed the disadvantages and justified the applicant in proceeding notwithstanding the deprivation of liberty (see [16]-[18] of the judgment).

An interim order was made pending a full hearing (see [4] of the judgment).

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