Alexander Ruck Keene KC (Hon)

“knows everything about Court of Protection.” Chambers and Partners 2024

Alex has been recognised for several years as one of the leading experts in the Mental Capacity Act 2005. He is instructed in cases by individuals, NHS bodies, local authorities, as well as foreign governments. He is one of the very few practitioners who has experience of appearing/advising upon all aspects of the Court of Protection’s jurisdiction. Because Alex’s work straddles policy, academia and practice, he tends now to be instructed in cases raising novel points of law or policy, frequently at appellate level.

Cases of Note:

• Re Sudiksha Thirulamesh (dec’d) [2024] EWCA Civ 896 – what is to happen where a person appears not to believe their doctor 
• R (Maguire) v His Majesty's Senior Coroner for Blackpool & Fylde & Anor [2023] UKSC 20 – the application of Article 2 ECHR in the context of those subject to the Deprivation of Liberty Safeguards
• Re JB [2021] UKSC 52 - The first case in which the Supreme Court considered the approach to capacity, in the context of sexual relations. 
• Re D [2019] UKSC 42 - The case in which the Supreme Court determined the meaning of deprivation of liberty for 16 and 17 year olds with impaired capacity. 
• An NHS Trust v Y [2018] UKSC 46 - The case in which the Supreme Court confirmed that there is no obligation to seek Court of Protection approval before withdrawing life-sustaining treatment where there is agreement as to what is in the person’s best interests.  
• N v ACGG [2017] UKSC 22 - The case in which the Supreme Court definitively determined how best interests decision-making interacts with public law decision-making. 
• R(LF) v HM Senior Coroner for Inner South London [2017] EWCA Civ 31 - The case determining the meaning of the concept of deprivation of liberty in the intensive care setting,.  
• Aintree University Hospitals NHS Trust v James [2013] UKSC 67 - The first case in which the Supreme Court considered the MCA 2005, in the context of delivery of treatment at the end of life. 
• The Health Service Executive of Ireland v Moorgate [2020] EWCOP 12 - An example of the international cases Alex does, in which Mr Justice Hayden ‘stress-tested’ the relative protections of Schedule 3 to the Mental Capacity Act 2005 and domestic legislation relating to compulsory mental health treatment.  Alex also co-wrote on The International Protection of Adults (OUP, 2015), the first book to examine the cross-border protection of the property and persons of adults with impaired capacity.  

Alex is heavily involved in the development of mental health policy.   He spent 2018 as legal adviser to the independent Review of the Mental Health Act 1983, whose report can be found here.  Alex’s instructions in the mental health field include, in addition to those noted below, (unreported) cases concerning remote assessment during the pandemic.  Alex also co-leads the Mental Health, Ethics and Law MSc course at King’s College London, and was a senior researcher on the Mental Health and Justice project which ran from 2017-2022. 

Cases of Note:

• R (Worcestershire County Council) v Secretary of State for Health and Social Care [2023] UKSC 31 – The meaning of ‘ordinary residence’ in the context of s.117 MHA 1983 
• Sessay v (1) South London & Maudsley NHS (2) Met Police [2012] 2 WLR 1071 - The case in which the Divisional Court had to consider for the first time the powers under which incapacitated patients can be required to remain upon hospital premises pending their admission under the MHA 1983
• TTM (By His Litigation Friend TM) (Claimant) v (1) Hackney London Borough Council (3) East London NHS Foundation Trust (Defendants) & Secretary of State for Health (Interested Party) [2011] 1 WLR 2873 - In this case, the Court of Appeal determined authoritatively the scope of Articles 5(1) and 5(5) European Convention on Human Rights in the context of admission for treatment under the MHA 1983.  
• Munjaz v United Kingdom  [2012] ECHR 1704 - The European Court of Human Rights gave guidance both as to the operation of Articles 5 and 8 ECHR in the context of detained patients facing seclusion.

Alex has had a long-standing interest in healthcare matters, especially those raising ethical dilemmas. He is on the British Medical Association’s Medical Ethics Committee and the Legal and Ethical Policy Unit of the Faculty of Intensive Care Medicine, intervening on the Faculty’s behalf in cases up to and including the Supreme Court.   He has been a legal member of working groups convened to produce guidance by bodies including the British Medical Association, the Royal College of Physicians and the Association of Anaesthetists of Great Britain and Ireland.  He sits on two clinical ethics committees, one run by a major teaching hospital, and one by a large mental health trust. 

Cases of Note:

• R (JJ) v Spectrum Community Healthcare CIC [2023] EWCA Civ 885 – Could a capacitous quadriplegic prisoner demand to be fed boiled sweets and crisps in the face of concerns from the healthcare team that such would lead to him choking? 
• Rashid Maqsood Abbasi & Anor v Newcastle Upon Tyne Hospitals NHS Foundation Trust [2023] EWCA Civ 331 – When should clinicians be named in serious medical treatment cases? 
• AB v CD [2021] EWHC 741 (Fam) - A case in which the court had to address the question whether parents can consent to the administration of puberty blockers where their minor child seeks to consent.
• NHS Trust v X [2021] EWHC 65 (Fam) - The first post-HRA case to consider whether the refusal of treatment by a minor is binding. 
• R (Conway) v Secretary of State for Justice [2017] EWCA Civ 1431 - The compatibility of the ban on providing assistance with suicide in s.2(1) Suicide Act 1961 with the European Convention on Human Rights.