This was another case involving dental treatment following shortly after the earlier case of United Lincolnshire Hospitals NHS Foundation Trust v Q  EWCOP 27.
In this case, MD is a 24-year-old man with diagnoses of learning disability, paranoid schizophrenia and ADHD. He also has a possible diagnosis of autism. He is voluntarily accommodated in a residential home for men with mental health problems. MD is a very vulnerable man with complex needs. His behaviour can be challenging, and he can become violent and aggressive.
MD has suffered from very poor dental health from some time. He has a sweet tooth and poor dental hygiene which has resulted in decaying teeth, missing teeth, retained dental roots, cysts and infection. This is a source of great physical pain and discomfort for MD who is now on a diet of soft foods. MD has refused dental intervention.
Mostyn J was satisfied that MD lacks capacity both to conduct proceedings and also to make decisions regarding his dental care, having been provided with capacity assessments and a full psychiatric report.
Mostyn J was also satisfied that it was in MD’s best interests to undergo treatment commenced covertly (i.e. without warning MD he was going to be taken to hospital) and with the use of chemical and physical restraint not least because he concluded, “if MD were to have a brief window of capacity, I am sure that he would consent to intervention as a necessary measure to avoid pain”.
Interestingly, the care plan proposed for MD’s treatment included minimising the use of his current caregivers in transporting him to the hospital, in order to maintain the relationship of trust with them.
Mostyn J also determined, having considered the proportionality of the same, to make a declaration in favour of a full dental clearance, rather than a partial clearance, on the basis that, given the evidence of MD’s inability to comply with elementary dental hygiene measures, any remaining teeth would soon decay and result in a similar application in the future.
The full judgement can be read here
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