Mother pregnant for sixth time unable to make her own decisions about treatment

Family|July 3rd 2014

A woman with autism and learning difficulties is unable to make her own decisions about healthcare, a court has ruled.

In The Mental Health and the Acute Trust v DD & Anor, the woman, referred to as ‘DD’, lived in a community placement with her partner, who also has learning difficulties. Her first five children, born between 2002 and 2013, had all been placed in care and subsequently adopted. The later pregnancies had been concealed from authorities. DD suffered from various health problems, including, during the fourth pregnancy, seizures and a haemorrhage.

In April this year, her home was forcibly entered by the authorities and she was taken to a psychiatric unit for an assessment of her mental health issues. DD was formally diagnosed with “mental disorder namely Childhood Autism and borderline Learning Disability.”

During the various examinations, doctors discovered that DD was pregnant once more. After returning home she did not attend subsequent antenatal appointments and did not engage with legal or healthcare professionals.

The local authority applied to the Court of Protection in London for a declaration that the woman lacked the capacity to her own decisions, in particular with relation to the antenatal examinations she had failed to attend. The Court was asked to decide whether such examinations would be in her best interests and whether she should be restrained if required.

A diagnosis of DD by a psychiatrist highlighted:

“…a family history of [Autistic Spectrum Disorder], a significant delay in DD’s development of language, early evidence of poor social interaction and imaginative play as well as ritualistic and controlling behaviour.”

Mrs Justice Pauffley concluded that there was sufficient evidence to make a declaration under Section 48 of the Mental Capacity Act 2005. This states that:

“The court may, pending the determination of an application to it in relation to a person (“P”), make an order or give directions in respect of any matter if—

(a)there is reason to believe that P lacks capacity in relation to the matter,

(b)the matter is one to which its powers under this Act extend, and

(c)it is in P’s best interests to make the order, or give the directions, without delay.”

The judge noted that DD had initially been distressed when the authorities entered her home in April but then both she and her partner calmed down and co-operated because they recognised the police officers as “authority figures”.

“A picture emerges of DD being willing to comply with medical assessments and interventions so long as she knows there is some associated structure and authority.”

Given her history of multiple pregnancies, DD’s wish to avoid antenatal appointments was irrational and not in her best interests, said the judge. However, a consultant obstetrician due to see DD planned to try and persuade her to cooperate with the examinations, winning her confidence and exploring her expectations and hopes in relation to the pregnancy. He did not plan to use restraint or sedation “in any circumstances”.

The judge concluded:

“Thus it seems to me that there is every potential for DD’s wishes and feelings to be very largely accommodated in relation to individual clinical assessments once she realises there is underlying authority.”

Read the full judgement here.

Photo by  surroundsound5000 via Flickr under a Creative Commons licence

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