University Hospital Coventry and Warwickshire NHS Trust v K and Mrs W

In University Hospital Coventry and Warwickshire NHS Trust v K and Mrs W [2020] EWCOP 31, a woman in her mid-30s had recently been diagnosed with cancer. Without radiotherapy and chemotherapy, she would likely die a painful death within a year. The treatment offered a 30-40% prospect of survival for more than 5 years, after which she would have a normal life expectancy. However, the treatment would render her infertile as it would expedite the menopause. K had been enthusiastically cooperative with treatment so far, but there was much worse treatment to come.

The reasons behind the application were threefold:

1. It was highly intrusive treatment over a considerable period of time;
2. It would cause infertility;
3. There was a distinct possibility K might withdraw her cooperation when the treatment became more distressing.

The pre-emptive, rather than reactive, nature of the application was commended by the court. On the evidence, Hayden J concluded that K lacked capacity to consent to treatment because she was unable to retain the relevant words and concepts to evaluate them so as to be able to use or weigh them. In terms of best interests, 10 radiotherapy sessions and 2 sessions of chemotherapy were proposed, during which it may be necessary to address her anxiety with sedative medication. If she were to refuse to attend hospital for treatment, he agreed that it would not be in her best interests to compel her to travel there. Indeed, he agreed with the clinicians that to restrain would be more likely to exacerbate her withdrawal than encourage her cooperation.