In what is the first decision to be handed down in 2024, the Court of Protection was asked to determine whether it was lawful and in a person’s best interests to receive care and treatment to which they were opposed, even if that necessitated the use of sedation.
Re TTN [2024] EWCOP 1 concerned a patient detained under Section 3 of the Mental Health Act 1983, who had experienced significant sight loss as the result of a detached retina.
He has a history of treatment resistant schizo-affective disorder characterised by a belief that people are not qualified in the way they say they are and cannot be trusted.
He was, however, distressed by the loss of sight and therefore wished the operation to take place, just not at the applicant hospital because he believed it has associations with the security services.
Expert evidence concluded his strong, delusional beliefs prevented TTN from understanding the full consequences of the proposed procedure. As a result, it was determined he lacked capacity to participate in the proceedings and make decisions as to treatment.
The question to be determined was therefore one of best interests.
Here, it was noted a detached retina is usually regarded as a medical emergency hence the sooner it is treated, the better the prognosis. In TTN’s case, the prospects of success were placed at between 40-60% of improved vision as well as mental state by allowing him to regain some of the independence currently lost.
His brother was also keen for him to have the operation and was supportive of the application.
Without surgery, there was a 70-80% chance of blindness.
Having been convinced TTN was in extremely capable hands and taking into account all of the circumstances, the judge determined the operation should succeed.
The full judgment can be accessed here.
This case serves as a useful reminder of the factors to be considered when determining whether a person is able to understand, use or weigh information relevant to a decision and provides a good example of how such functions can become fundamentally undermined by, in this instance, irrational, paranoid beliefs about the hospital as well as those lined up to provide treatment.
Gemma Quinn is a Senior Associate in the Casualty team based in Manchester and lead of the Court of Protection subject matter group.
“TTN has strong delusional and psychotic beliefs which impact his ability to use and weigh the relevant information. TTN said that he would not have surgery under the person who had offered it to him, because he was “not qualified.”
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