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Report No. 196

(9) Re T (adult: refusal of medical treatment), 1992 (4) All ER 649=1992 (3) WLR 782

(Lord Donaldson of Lymington, Butler-Sloss and Staughton LJJ) (d. 30.7.92)

The case related to an adult patient, a lady T, who was injured in an accident on 1.7.92. She was 34 weeks pregnant and required blood transfusion. She was brought up by her mother, who was a Jehovah's witness, but the patient was not herself a member of that religious sect. The patient told the staff nurse after a private conversation with her mother, that it was sinful to have blood transfusion according to the beliefs of that sect. She then blindly signed a form of refusal of consent to blood transfusion after the caesarian operation.

The consultant, therefore, hesitated to give her blood transfusion and put her on a ventilator and some drugs. Her father and her boyfriend applied to the court in an emergency hearing for authorization of blood transfusion, and the judge authorized blood transfusion and stated that, in the circumstances prevailing, it was not unlawful to do so and was in the "best interests" of the patient. The learned Judge observed that at the emergency stage, the patient had not objected and hence the blood transfusion at that stage was lawful.

On appeal by T, the Court of Appeal observed that certain earlier decisions cited by Counsel were distinguishable and as the patient was not a minor, permission of Court was not necessary to give blood transfusion.

It was further held that although prima facie, every adult had the right and capacity to decide whether he or she would accept medical treatment, even at the risk of permanent injury to health or premature death, and regardless of whether the reasons for refusal were rational or irrational, or were unknown or non-existent, still if an adult did not have the capacity, at the time of the purported refusal and continued not to have that capacity, or if his or her capacity to make a decision had been overborne by others, it was the duty of doctors to treat him in whatever way they considered, in the exercise of their clinical judgment, to be in his best interests.

It was held, on the facts, that the doctors had been justified in disregarding T's instructions and in administering blood transfusion as a matter of necessity since the evidence showed that T had not been fit to make a genuine decision because of her medical condition and that, in fact, she was subjected to the undue influence of her mother, which vitiated her decision to refuse blood transfusion. The appeal was dismissed.



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