This application before District Judge Bellamy concerned the legality of providing covert medication to patients subject to DOLS authorisations and the attributability of the State. Background
The council raised concerns in October 2014 that AG, now aged 92, had been living in squalor without a fridge, cooker or food. She appeared unkempt and there were concerns she was not taking prescribed medication as required. After suffering a fall in November 2014, AG was placed in a home. A standard authorisation was granted under Schedule A1 of the Mental Capacity Act 2005 to authorise AG's deprivation of liberty from 18th December 2014 to 17th December 2015. On 7th July 2015 an application was made challenging this standard authorisation to consider whether AG can be safely managed within the community. Dr Swamiraji diagnosed AG with Alzheimer's and concluded AG lacked capacity to make decisions regarding her care, accommodation and treatment. Her care plan involved the administration of medication covertly, which had not been assessed in December 2014 as required by Schedule A1. It was accepted by all parties that if AG did not receive any medication she was at risk of both physical and mental deterioration. District Judge Bellamy therefore needed to decide whether there was any infringement on AG's Article 5 and 8 rights. Decision District Judge Bellamy found that covertly administering medication infringed the right to a private life under Article 8 ECHR. Additionally, it was held that when she was admitted to the home AG was deprived of her liberty within the meaning of Article 5 of the ECHR. The objective test in P v Cheshire West was met as AG is under constant supervision and control of her carers and not free to leave. The subjective test is also met as AG lacks capacity. Therefore, arrangements for AG's accommodation are attributable to the State. All parties agreed that covert medicines should only be used in exceptional circumstances and the Judge commented: "The use of medication without consent or covertly whether for physical health or for mental health must always call for close scrutiny. It seems to me that there is good reason to pay close regard to the justification for medication especially if as in this case it potentially impacts upon a person’s behaviour or mental health or is a sedative in effect." Discussion Clearly the use of medication without consent or covertly must always call for close scrutiny. District Judge Bellamy provided a procedural guide which may be of assistance in future cases:
Read the full text of the judgment here Judgment concerning the administering of covert medication on the P who was subject to a DOLS standard authorisation. The judgment includes some really useful guidance on the involvement of the family and the health professionals in the best interests assessment and the need for regular reviews where covert medication is being administered.
Read the full text of the judgment on Bailii Daughter's application for the continuation of a RRO after her mother (who was in a minimally conscious state) died following the withdrawal of life-sustaining treatment by means of clinically assisted nutrition and hydration. The application was refused, the judge saying that "the balance here weighs more heavily in favour of freedom of expression".
Read the full text of the judgment on Bailii The judge agreed with the treating clinician that the P, who has a diagnosis of an emotionally unstable personality disorder and schizophrenia, lacked capacity to make decisions on the issue of her treatment in relation to receiving anticoagulation medication and that it was in her best interests to receive such treatment.
Read the full text of the judgment on Bailii After concluding that the Patient was in a Persistent Vegetative State, the court made declarations that it was no longer in her best interests to continue to receive artificial nutrition and hydration, and that it was lawful and in her best interests for artificial nutrition and hydration to be withdrawn.
Read the full text of the judgment on Bailii |
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