TS, Re (Pacemaker) [2021] EWCOP 41

Judgment concerning capacity and best interests of TS, together with an application for a deprivation of liberty order, who has a delusional disorder but needs to have a pacemaker fitted.

TS was in a Catch 22 situation as unless he receives antipsychotic medication, the delusional disorder will not improve and he will not be able to regain capacity, but he cannot receive certain types of antipsychotic medication until the pacemaker is fitted due to his heart condition. The delusions TS exhibits centre sound claims that he has been persecuted by various police, medical and local authorities over the years and at the time of the hearing, he did not believe he had any mental health problems.

After reviewing the relevant law around capacity and best interests, Peel J agrees with the clinicians that TS lacks capacity and that it is in his best interest to have the pacemaker fitted against his will broadly because:

• TS’s delusional belief meant his views therefore cannot carry predominant weight. 
• If the pacemaker is not fitted then there is a probability of premature death and he had not heard anything to displace the presumption in favour of prolonging life. 
• ​it is a standard, low risk, procedure 
• There is a possibility of a risk to TS’s mental health if the procedure is carried out, as it will be, against his will but the benefits significantly outweigh the risks and future treatment with antipsychotic medication would at least ameliorate the consequences. 
• TS is in reasonably good health
• TS, in the past when capacitous, had not opposed other treatments so it seemed to Peel J that it is likely that he would consent to the procedure if he had capacity
• ​At present, TS experiences a much reduced quality of life living in a unit where he does not wish to be. If the pacemaker is fitted there is every possibility he will be able to go home

Peel J also approved the potential deprivation of liberty but, in the event, the procedure was carried out without incident.

Read the full judgment on Bailii.