Doctors treating a 14 year-old girl who had taken an overdose must treat her despite her refusal to consent, a High Court Judge ruled this summer.
The teen in question, ‘YZ’, has been rushed to the A&E department of Plymouth hospital one night in July after telling a neighbour that she had taken an overdose. She had stormed out of her family home following an argument with her mother. This had been prompted by text sent to the mother by a friend of YZ claiming her daughter had been raped and fallen pregnant.
The mother later reported that she had previously tried on several occasions to have her troubled daughter assessed by a psychiatrist.
At the hospital YZ gave contradictory accounts of how many paracetamol tablets she had taken, ranging from two or three, to “some”, to a whole “strip”, i.e. ten to 12, thereby taking her close to a toxic dose for someone of her size (around 20 tablets). They were keen to begin treatment to avoid the risk of serious liver damage while conducting tests to try and ascertain just how much the teen had taken. It was necessary to begin the treatment within 24 hours for it to have any real chance of success.
YZ was uncooperative, repeatedly agreeing to treatment and then refusing at the last minute. Her mother told medical staff that her daughter was prone to fits of stubborn behaviour in which she would refuse anything for several days at a time.
With the deadline fast approaching, the doctors rushed for legal permission to begin the treatment in spite of YZ’s refusal to consent, and for a declaration that the teen lacked ‘capacity’, i.e. the ability to make informed decisions about her own welfare. Submissions were made over the telephone. In a recently published High Court ruling, Mr Justice MacDonald explained:
“…that the application for orders in respect of YZ’s treatment first came before me only 15 minutes or so before the window for optimum treatment advised by the specialist unit in YZ’s case came to an end [i.e. within 24 hours].”
A point of contention was whether or not YZ was Gillick competent – i.e. sufficiently mature to consent to her own medical treatment, without the permission of their parents or other authority figures. A doctor believed she was, but there was also evidence that she had experienced sexual grooming, along with the friend’s claim that she had been raped. In addition, her mental health was open to debate, although she had not been formally diagnosed.
The Judge noted:
“Within this context, there was some doubt regarding the question of Gillick competence.”
Judge MacDonald quickly concluded that there was no time to waste, he explained in his later written judgement.
“Having regard to all these factors, and having YZ’s welfare as my paramount consideration, I was entirely satisfied that it was in YZ’s best interests to make the orders sought. I agreed to grant the orders sought as being in YZ’s best interests and an order was drafted … and approved by myself.”
You can read Plymouth Hospitals NHS Trust v YZ & Others here.
Image by Sam-Cat via Flickr under a Creative Commons licence