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Hysterectomy can be performed on woman with schizophrenia against her will, judge rules

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7006 (Published 16 October 2012) Cite this as: BMJ 2012;345:e7006
  1. Clare Dyer
  1. 1BMJ

A High Court judge in London has given doctors the go ahead to perform a risky but potentially lifesaving hysterectomy on a woman with cancer of the uterus who denied that she had the disease.

Mr Justice Holman ruled that it would be lawful for an unnamed NHS trust in the south of England to carry out the operation on the 61 year old woman with schizophrenia, who lacked the mental capacity to make an informed decision for herself.

The judge, sitting in the Court of Protection in London, was told that the woman, named only as K, had diabetes and asthma and weighed 20 stone (127 kg). But her three adult sons wanted her to live, and they and the doctors caring for her believed that the benefits of the operation would outweigh the risks.

If untreated, doctors said, the cancer could spread to her bowels and bladder, causing her “pain and indignity before death.”

The official solicitor for England and Wales, acting for K, argued that the operation would be too risky, carrying a 5-10% chance of death. In cases of this sort, where the other parties agreed on a course of action, the official solicitor would often argue the opposing case to make sure that the judge heard both sides of the argument.

Mr Justice Holman said that K “utterly denies that she has cancer” and “has a delusional belief that she does not have cancer at all.”

He added, “She has cancer of the uterus. She could be cured by a potentially lifesaving operation. However, because of other comorbidities and other factors there is a considerable risk that she could die during the operation or in the postoperative recovery period.

“She herself lacks the capacity to make an informed decision. She denies that she has cancer at all and opposes, and is resistant to, the operation.”

He continued, “The lady’s three adult sons all strongly desire that she should have the operation and feel that the potential benefits outweigh the risks. The question for the court is whether, balancing all the relevant factors, it is in her overall best interests to have the operation or not.”

The judge granted the trust a declaration that performing the proposed surgery under general anaesthetic would be lawful “notwithstanding K’s refusal to consent to such treatment.” He concluded, “Assuming the surgery takes place, it is of course my fervent hope that it proceeds as smoothly as possible to a good outcome for Mrs K.

“Like her sons, I fully appreciate that it may not. I, like they, have tried to do my very best for her.”

Notes

Cite this as: BMJ 2012;345:e7006