Kings College London NHS Trust v FG
This case concerned FG, a 37 year old man with schizophrenia, who was being cared for at SLAM, apparently detained under the MHA 1983. He sustained a fracture and dislocation to his shoulder, which required treatment under general anaesthetic, but he refused to consent to the operation. His reasons included that he was worried about the effect of the general anaesthetic on his heart, its potential interplay with the medication clozapine which he was taking, and that the surgery had been ordered by M15. The court found no difficulty in concluding that he lacked capacity to make a decision about the operation given the influence of his paranoid and persecutory beliefs.
It was similarly clear that treatment was in his best interests, notwithstanding his expressed wishes - he was in pain, and without treatment would be unable to participate in activities he enjoyed in the future such as fishing and wood chopping. Francis J approved the care plan, including the administration of sedating medication covertly, saying in respect of that issue:
I accept that there can be exceptional circumstances in which the administration of covert medication is better than forced chemical injection under restraint. There would be very few circumstances in which it will be appropriate to administer covert medication in this kind of way and each case will have to be decided on its own facts. I do not imagine there are any rules or specific guidance that one could set out. A judge would have to decide it on a case by case basis. But having regard to the mental health and physical health matters to which I have just referred, I am satisfied that if the surgery is to take place there should be permission to the treating team to administer covert medication in this way to sedate him.
In a further reminder that deprivation of liberty has not been entirely removed from the hospital setting by Ferreira, Francis J accepted – as it was by the Official Solicitor – that "the proposed procedure will amount to a deprivation of his liberty and I authorise that deprivation of his liberty to the extent that is necessary and on the basis that any measure used to facilitate or provide the arrangements shall be the minimum necessary and that all reasonable and proportionate steps are taken to minimise distress to FG and to maintain his dignity."