Doctors ‘can perform caesarean on pregnant woman against her will’

Doctors treating a mentally ill woman can conduct a caesarean section against her will, the Court of Protection has ruled.

The unnamed woman, in the final stages of pregnancy, has insisted she does not want a C-section. But her medical team told Mr Justice Hayden that she has bipolar affective disorder, as well as a history of both depression and psychosis and they believe there is a real risk that she could relapse while in labour and make irrational decisions if serious complications occur.

The Court of Protection is a division of the High Court which makes decisions on behalf of people who lack ‘capacity’ through illness or disability: the ability to make rational decisions about their own welfare.

If the woman in question suffered a relapse under the stresses of labour, the delivery room doctors could be faced with the need to make rapid decisions and asked the Court for the legal right to perform a caesarean section or related treatment even if she refused permission.

The urgent application was made jointly by the women’s obstetric and psychiatric teams.

Barrister Bridget Dolan QC explained:

“Anticipatory orders and/or declarations are therefore sought to enable the lawful provision of such care and treatment as is clinically indicated, including emergency caesarean section, to [her] and her unborn child to ensure their health and safety and to minimise the risk of any significant and long-lasting harm.”

Mr Justice Hayden described the case as “exceptional” and said the order he had been asked to make was “draconian”. The Court of Protection was rarely asked to consider cases in which the subject might lose capacity in the future, he noted.

But the best interests of the woman and her child were paramount, he concluded and protecting those meant granting the doctors the legal right to conduct a C-section against her will if one was required.

This is an interesting development in an area of law which often overlaps with family law. It is therefore worth noting these decisions and the impact they can have on the family and individuals concerned.

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