This was an urgent application concerning medical treatment for MN, a 60-year-old man diagnosed with paranoid schizophrenia. He has an obstruction in his right kidney which is suspected to be related to bladder cancer. The applicants, University Hospitals of Derby and Burton NHS Foundation Trust, sought authority for investigation and possible treatment of MN against his wishes, which would likely require a degree of restraint which would amount to a deprivation of his liberty.
In August 2020, MN attended his GP because he was passing a coffee-like substance from his urethra. He co-operated with an ultrasound performed on 23 November 2020, but has since resisted further investigations or treatment. MN’s father died in 2017 having refused treatment for cancer, and professionals believe that MN wishes to follow his father’s precedent.
MN’s urologist, Mr W, considers that MN’s symptoms strongly indicate that he has bladder cancer but, without a CT scan, this cannot be confirmed. If MN does have bladder cancer, if left untreated, there is a risk that he will suffer a painful deterioration due to blood clots forming in his bladder and he could be prevented from urinating. Whilst the precise timescales are unknown, without a cystoscopy procedure, MN may experience a quicker and more unpleasant death resulting from a cancerous growth metastasising.
Unfortunately, Hayden J was advised that any proposed treatment was likely to be delayed, due to the severe restriction on the number of beds available to elective surgery patients as a consequence of Covid-19.
Hayden J found “that it would be inconsistent with the principles of the MCA 2005 for the Court pre-emptively to authorise the deprivation of MN’s liberty in circumstances where both the nature of the potential emergency situation could be anticipated (the foreseeable impact of blood clotting related to bladder cancer), and where MN’s wishes and feelings might be sought and recorded in advance”, and he directed that the interim order sought by the applicants is only operative in certain limited circumstances. The matter was listed for a final hearing in mid-March 2021 when it is hoped that the position within hospitals will look much better.
The full judgement can be read here
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