In a ruling which underlines that mental illness does not necessarily equate to legal incapacity, the Court of Protection recently refused to open the way for doctors to perform a life-saving leg amputation on a woman with paranoid schizophrenia who had refused to consent to the operation.

What started as a superficial ulcer on the woman’s right foot had turned gangrenous and, after the foot became mummified and ‘came off’ of its own accord, surgeons advised the woman that she would have to lose her leg or risk losing her life. However, she refused to agree to the operation.

In those circumstances, lawyers representing the Heart of England NHS Foundation Trust asked the Court to declare that she lacked the mental capacity to make a rational decision for herself. Such a declaration would have enabled doctors to carry out the procedure lawfully.

Mr Justice Peter Jackson stressed that many people who suffer from mental illness are capable of making decisions about their medical treatment and ‘it is important not to make unjustified assumptions to the contrary’.

In this case, the Court found that the woman’s mental illness had not robbed her of her freedom of choice and that the Trust would have to abide by her wishes. Whilst she undoubtedly did have a ‘disturbance in the functioning of her mind in the form of paranoid schizophrenia’, it had not been established that she thereby lacked the capacity to make a decision about surgery for herself.


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