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Mentally disordered or lacking capacity? Lessons for management of serious deliberate self harm

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4489 (Published 07 September 2010) Cite this as: BMJ 2010;341:c4489

This article has a correction. Please see:

  1. Anthony S David1,
  2. ,
  3. Matthew Hotopf, professor1,
  4. Paul Moran, consultant psychiatrist1,
  5. Gareth Owen, researcher1,
  6. George Szmukler, professor1,
  7. Genevra Richardson, professor2
  1. 1Institute of Psychiatry, King’s College London, Denmark Hill, London SE5 8AF
  2. 2School of Law, King’s College London, Strand, London WC2R 2LS
  1. Correspondence to: A S David anthony.david{at}kcl.ac.uk
  • Accepted 25 June 2010

How do you manage a patient who has self harmed but states she doesn’t want life saving treatment? Anthony David and colleagues draw on the case of Kerrie Wooltorton to discuss the difficulties, and in an accompanying article Navneet Kapur and colleagues consider the validity of advance directives

Kerrie Wooltorton died aged 26 on 19 September 2007 from deliberate self poisoning with antifreeze after refusing treatment. The cause of death was recorded as ethylene glycol toxicity. At an inquest on 20 September 2009, William Armstrong, coroner for Greater Norfolk District, concluded she was legally competent to decide. However, the case highlights several ethical and practical problems. Although we do not have all the necessary clinical details, we have used the coroner’s report to bring out some important points that might prove helpful for clinicians confronted with a person with potentially fatal self harm who is refusing life saving treatment. We intend no criticism of the clinicians involved; we comment with the benefit of hindsight—a luxury they did not have.

Synopsis based on coroner’s report

Miss Wooltorton started self harming behaviour at the age of 15 and was described as having an emotionally unstable personality disorder. She had received considerable support from her local mental healthcare services. In the last year of her life she had been admitted to hospital several times after drinking antifreeze and bleach, and the inquest heard that she had been uncooperative and refused medication. In March 2009 she was admitted under section 3 of the 1983 Mental Health Act. The section was rescinded after four days, and Miss Wooltorton was discharged from hospital a week later amid optimism regarding behaviour change; she was readmitted after two days because of recurrent thoughts of taking antifreeze. Her mental state fluctuated, and she had further episodes of low mood and self poisoning with antifreeze; …

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