In a significant judgment for both inquest and mental capacity law, the Court of Appeal has today handed down judgment R (oao Maguire) v HM Senior Coroner for Blackpool & Fylde  EWCA Civ 738.
Jackie Maguire was 52 when she died in February 2017 after days of being acutely unwell. Jackie had learning disabilities and Down’s syndrome and struggled to communicate. She lived in a care home under a deprivation of liberty authorisation and lacked capacity to make decisions about her residence and care. She also lacked capacity to make decisions regarding medical treatment. In the days leading up to her death she sought help from her carers, her GP, the ambulance service and the out of hours GP service. Due to her learning difficulties and her fear of hospitals, however, when attempts were made to take her to hospital, she refused. The evidence at her inquest was that there was no system in place to take her to hospital safely in light of her refusal, even though all parties involved agreed she lacked capacity to consent to treatment or decide what treatment she needed.
Having initially determined that Article 2 was engaged in the inquest into Jackie’s death that followed, the Coroner subsequently changed his mind so that the wider question of how Jackie died was not left to the jury. This decision was challenged by way of judicial review and upheld; it has now been upheld once more by the Court of Appeal.
The Court of Appeal held that Jackie’s death was essentially connected to her seeking “ordinary medical treatment” and that as a result, the Article 2 operational duty of the state to protect life was not engaged. Further, that given the medical nature of her death, the procedural obligation was met by an effective judicial system to determine liability: no further investigation by way of an Article 2 compliant inquest was required. The Court also determined that the “very exceptional circumstances” which might give rise to an Article 2 duty in a medical case did not come into play in Jackie’s place on the basis that there was no systemic or structural dysfunction in the medical services provided to her.
Victoria Butler-Cole QC and Nicola Kohn appeared for the appellant instructed by Bindmans LLP.