GTI, Re [2020] EWCOP 28

This was an application for declarations and orders pursuant to the Mental Capacity Act 2005 in respect of P to undergo medical treatment which was against his wishes regarding the insertion of a PEG.

P had an established history of schizoaffective disorder which had been controlled with psychotropic medication, and he had lived in supported accommodation in the community. P stabbed himself in the neck during what appeared to have been a paranoid episode which caused significant damage to his recurrent laryngeal nerve.  It became apparent after surgery that the neurological damage had affected his swallowing reflex and therefore, he was unable to eat or drink without significant risks of aspiration. The risks associated with this led to respiratory arrest.

P resisted any attempts to insert a PEG, naso-gastric tube or total parenteral nutrition lines, which resulted in significant weight loss, nearly 30% of his body wight. At a clinical decision-making meeting on 20 May 2020, it was concluded that the insertion of a PEG was in P’s best interests. The NHS Trust therefore applied for declarations and orders that it was in his best interests to undergo this medical treatment urgently.

The Court considered medical evidence on PEG as well as P’s wishes, and concluded that P lacked capacity to take the decision in relation to the PEG procedure, and that it was in P’s best interests to undergo the procedure and therefore made the declarations sought.

The full judgement can be read here

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