Mental health – Persons who lack capacity – Court of Protection
 EWHC 454 (COP)
26 February 2014
Court of Protection
Mr Justice Peter Jackson
Mental health – Persons who lack capacity. An application was made by the NHS Trust for a declaration that it would be lawful to withhold a blood transfusion from LM, a gravely ill 63-year-old female Jehovah’s Witness. The Court of Protection held, considering the concept of capacity under the Mental Capacity Act 1983, that LM had the capacity to decide whether to accept or refuse a blood transfusion and that decision taken by LM prior to her loss of capacity was applicable to her later more serious condition.
The judgment is available at:  EWHC 454 (COP)
LM had no known relatives. She had a background history of depression and paranoid schizophrenia and in the past had received compulsory treatment. She had been a Jehovah’s Witness since the 1970s at least. In the middle of January 2014, LM was seen by a consultant psychiatrist, who had known her for seven years. He felt that her mental health was as good as he had known it for a number of years. In February 2014, LM was admitted to hospital by ambulance, having been found wandering and confused outside her home. She had a number of bruises, suggesting recent falls. From the outset of her admission it was known that she was a Jehovah’s Witness and her notes were marked that she was not to receive blood products in any circumstances. LM was found to have a large duodenal ulcer and on 13 February her condition deteriorated markedly to the point where she clearly lacked capacity to make or communicate a decision. On 18 February, an application was made by the National Health Service Trust for a declaration that it would be lawful to withhold a blood transfusion from LM. The medical view was that LM might not survive for as long as a day in the absence of a blood transfusion and that even if one was given, she might still die. The court decided that it was lawful for the doctors treating LM to withhold blood transfusions or administration of blood products notwithstanding that such treatments would reduce the likelihood of her dying and might prevent her death.
The issues were, inter alia: (i) whether LM had had the capacity to make a decision to refuse a blood transfusion before she had become unable to do so; (ii) whether her earlier decision applied to her later circumstances; (iii) alternatively, if the answer to either of the above questions was ‘no’, whether the Trust’s proposal to withhold a transfusion was in her best interests. The Trust’s submission was that LM had clearly made her wishes known even with knowledge of death. Alternatively, if it was a matter of best interests, the Trust did not wish to act against her wishes, being concerned to respect her individual dignity. Consideration was given to the Mental Capacity Act 1983.
The court ruled:
In relation to capacity, the court found that prior to the afternoon of 13 February, LM had had the capacity to decide whether to accept or refuse a blood transfusion. LM had understood the nature, purpose and effects of the proposed treatment, including that refusal of a blood transfusion might have fatal consequences. The decision that had been taken by LM prior to her loss of capacity was applicable to her later more serious condition. There had been no difference in kind and the court was satisfied that she had intended her decision to be effective in the circumstances that subsequently arose (see  of the judgment).
LM had made a decision that the doctors rightly considered had to be respected (see  of the judgment).
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