Livewell Southwest Community Interest Company v MD
Livewell Southwest Community Interest Company v MD [2020] EWCOP 57 is another case on full-dental clearance following very shortly after the United Lincolnshire Hospitals NHS Trust v Q [2020] EWCOP 27 case.
The Livewell case concerned MD, a morbidly obese 24 year old man with learning disabilities, paranoid schizophrenia and ADHD and a possible diagnosis of autism. Rather surprisingly, given his significant mental impairments, the judgement records that MD is voluntarily accommodated in a residential home for men with mental health problems.
In a hearing before Mostyn J it was detailed how, by virtue of his sweet tooth and resistance to dental hygiene, MD's teeth had reached a state where they were considered to pose a risk of infection, sepsis and even death if untreated. Due to MD's resistance to intervention and his significant size, the applicant sought orders that would authorise both sedation in the community, soft handcuffing if necessary, and transfer to hospital. This was all in the context of MD having expressly indicated an unwillingness to have any teeth removed – albeit that the evidence pointed to this being due to concerns regarding the pain that might involve, rather than aesthetic ones.
Mostyn J had no difficulty making declarations as to MD's lack of capacity to conduct proceedings and make decisions regarding his dental treatment, having been provided with a full psychiatric report.
As to best interests, he determined that it was in MD's best interests to undergo treatment commenced covertly (ie without warning MD he was going to be taken to hospital) and with the use of chemical and physical restraint not least because he concluded, "if MD were to have a brief window of capacity, I am sure that he would consent to intervention as a necessary measure to avoid pain" (para 17).
Interestingly, the care plan proposed for MD's treatment included the enlisting of third party care givers, previously unknown to him, in order to maintain the relationship of trust with his current team. Mostyn J also determined, having considered the proportionality of the same, to make a declaration in favour of full rather than partial treatment on the basis that, given the evidence of MD's inability to comply with elementary dental hygiene, any residual teeth would inevitably decay and result in an identical application and procedure in future (see para 22).
