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Concerned parents cannot have Down’s daughter sterilised, court rules

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1138 (Published 19 February 2013) Cite this as: BMJ 2013;346:f1138
  1. Clare Dyer
  1. 1BMJ

A “delightful, warm, engaging, and affectionate” 21 year old woman with Down’s syndrome should not be sterilised despite her parents’ fears that she could be taken advantage of and become pregnant, a judge has ruled at the Court of Protection in London.

The woman, named only as K, a student at a college for people with learning disabilities, had a hormonal contraceptive implant inserted in her arm by her GP, but it was removed after causing significant changes to her temperament. Her parents wanted her to be sterilised and she was referred to an NHS gynaecologist, Dr X, who agreed to perform laparoscopic sterilisation.

A matron responsible for safeguarding vulnerable young adults learnt of the plan and advised that a “best interests” meeting should be held and a second opinion obtained. The second opinion doctor, Y, another gynaecologist in the trust, advised that K should have a Mirena coil if she needed contraception.

Two best interests meetings were held, the second including staff from the local authority. The second meeting decided sterilisation would not be in K’s best interests but sought a third opinion, from Dr Z. He advised that K did not need contraception yet because she was not in a sexual relationship; only if she became sexually active and an intrauterine device was unsuccessful should sterilisation be considered.

After the second meeting, K’s mother wrote to Dr X saying she and her husband intended to take K abroad in the future “to seek assistance with this matter both privately and confidentially.” The threat, and the fact that the summer holidays were about to start, prompted the local authority to take the case to court.

The local authority and the Official Solicitor (acting for K) jointly commissioned a report from Samuel Rowlands, clinical lead in community sexual and reproductive health at Dorset Healthcare University NHS Foundation Trust. In his opinion, as long as K was not at risk of pregnancy and showed no sign of initiating a sexual relationship, contraception would not be in her best interests.

If she did develop an intimate relationship and it was in her best interests to continue this, she should have an intrauterine device, he added. But sterilisation would not be in her best interests.

Mr Justice Cobb said Drs Y and Z endorsed that opinion and Dr X no longer argued for sterilisation. But while K’s parents now accepted that she should not have contraception or sterilisation at the moment, they did not want to rule it out for the future.

The judge made a declaration that sterilisation would be a “disproportionate”, and not the least restrictive, step to achieve contraception for K in the future. Although her parents expressed concerns that she was occasionally “tactile” and “over-familiar,” had begun to be more aware of the opposite sex, and was vulnerable to sexual exploitation, she was well supervised at home and at college and there was no evidence that she was seeking a sexual relationship. In the event of a need for contraception, less restrictive methods than sterilisation should be tried, the judge said.

He reminded doctors that non-therapeutic sterilisation counted as “serious medical treatment,” for which permission should be sought from the court before it was carried out on a patient who lacked the capacity to consent.

Notes

Cite this as: BMJ 2013;346:f1138