University Hospital Coventry and Warwickshire NHS Trust v K & Anor [2020] EWCOP 31

This matter concerned an urgent application by the Trust for an order confirming that P lacked capacity to consent to medical treatment for cancer, and that it was in her best interests to undergo a combination of radiotherapy and chemotherapy, with the intention of either curing the cancer or at the least providing P palliative and symptomatic relief.

Following a series of diagnostic investigations, P was referred to the Trust and informed of her diagnosis of cancer on 03/06/2020.  The Consultant Oncologist made every effort to explain matters carefully to P regarding her diagnosis and treatment, in order to allow P to absorb the complex and distressing news, however, whilst  P was able to understand some of the concepts, she was unable to retain them sufficiently well to be able to weigh and evaluate the contemplated treatment.   Following a further appointment with the Consultant Oncologist and Clinical Nurse Specialist, it was concluded that whilst P had a real understanding of her condition as being “serious” or “bad” she did not understand that this was a life-threatening illness.

Without the treatment it was determined that P would die within a year and her death would be painful and exacerbated by complications. The treatment had a 30-40% chance of being effective (i.e. a 30-40% prospect of survival for more than 5 years, after which it was considered P would have normal life expectancy).  The treatment would abate P’s current painful symptoms but would also trigger a premature menopause and leave P infertile.

There was consensus amongst the treating clinicians and P’s mother that the treatment was in P’s best interests. P was also cooperative in these initial early stages, however the decision to bring the matter before the Court was made for three principal reasons:

  • The treatment was extremely intrusive.
  • The impact of the treatment was significant, involving premature onset of the menopause and rendering P infertile.
  • The treatment plan was onerous and there was a possibility that P may withdraw her co-operation at a later stage.

The court approved the order sought and commended the Trust’s approach in making the application pre-emptively to facilitate good planning in circumstances which could become very difficult.  The court further commented that it provided an opportunity to assist Trusts more generally as to the kind of circumstances in which applications should be brought to the court.

The full judgment can be read here

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