[2014] EWCOP 1136
IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION
AND
IN THE COURT OF PROTECTION
Royal Courts of Justice
Strand
London WC2A 2LL
Before:
Mr Justice Holman
(sitting throughout in public)
(sitting as a judge of the High Court and of the Court of Protection)
No: N/A
Between:
Nottinghamshire Healthcare Nhs trust
Applicant
and
RC
Respondent
Miss B. Dolan (instructed by Nottinghamshire Healthcare NHS Trust) appeared on behalf of the Applicant.
THE RESPONDENT did not attend and was not represented.
1
This is an urgent without notice application which has been made to me late this afternoon in my capacity both as a judge of the High Court and also as a judge of the Court of Protection. I have heard this application from first to last in public. I arranged during the course of the hearing for representatives of the media to attend, if they wished to do so, and one is now present. I give this judgment publicly and it may be freely reported.
2
The application is made by an NHS Trust which appears to be the Trust responsible for a certain psychiatric hospital. The respondent to the application is a young male adult, now aged 23. He appears to have had a difficult background and upbringing since I am told that he spent the majority of his childhood in care. There is a statement signed and dated today by a consultant psychiatrist at the psychiatric hospital in which, as I will describe, he is currently compulsorily detained. That statement says that he suffers from "a severe personality disorder". A symptom of his disorder is that "he engages in significant self-harm through self-laceration and bloodletting, most recently by opening his brachial artery". As I understand it, it is not the opinion of the treating psychiatrist that he suffers from any kind of delusions or delusional disorder. His intelligence is within the range of normal and he appears (although this may require further exploration) to have capacity both to make decisions with regard to his medical treatment and also to instruct lawyers to conduct litigation on his behalf.
3
As a result of his medical disorder he has a history of compulsory detention under the Mental Health Act. Unfortunately, in 2012 whilst thus detained he committed an offence upon a staff member, as a result of which he was convicted and sentenced to five years' imprisonment. Recently he has been detained in prison serving that sentence. However, in the last two months or so he has once again been seriously self-harming whilst in prison. I have been told in a case summary prepared for this hearing by Miss Bridget Dolan, counsel who appears on behalf of the NHS Trust, that he "has a long history of significant and repeated self-harming behaviour. His self-harm includes self-strangulation with ligatures and plastic bags, burning himself, and self-injury, including head-butting and self-laceration. He frequently re-opens wounds to aggravate an existing injury and cause further damage and blood loss."
4
Another aspect of this case is that, because of some history of thrombosis, he is prescribed the anti-coagulant, Warfarin, which has the effect that when he does bleed, he bleeds more profusely than he might otherwise do. Another aspect of the case is that his parents are of the Jehovah's Witness faith. I understand (although this may later be corrected) that for an appreciable period of time he did not himself profess that faith, but in the last few months he has apparently embraced it and now professes and adheres to the tenets of that particular faith. I have been told in counsel's case summary that "He has stated that he now practises his religion by praying, reading the bible and reading The Watch Tower magazine. He reports that his religion is important in his life. He remains in contact with his father, who supports him in his faith." As is widely known, a tenet of the faith of Jehovah's Witnesses is a prohibition on receiving by transfusion blood or blood products.
5
According to counsel's case summary, "On 1 February 2014 when in prison he seriously cut his right arm, opening his brachial artery at the antecubital fossa with a razor blade. He had significant blood loss and his haemoglobin fell to an extremely life-threatening level. He was admitted to intensive care and a blood transfusion was advised. He refused blood products on the basis of his Jehovah's Witness faith. The treating hospital abided by his expressed wish, believing it to be capably stated." Happily, he in fact survived that event without any blood being transfused.
6
There were further incidents of self-harm and attempting to tear open his earlier wounds during the course of February 2014. So it was that on 12 March 2014 he was transferred from the prison where he was being detained to the psychiatric hospital in which he is now compulsorily detained by virtue of the provisions of sections 47–49 of the Mental Health Act 1983. Between 13 and 18 March 2014, at that hospital, he had to be placed in a form of severe mechanical restraint, effectively pinning his arms to the sides of his body, so as to prevent him from using his hands to self-harm. When that restraint was loosened on 18 March 2014, he once again began tampering with his wound, although only in a relatively minor way. He again re-opened his healing wound on 31 March 2014 and was again placed in a restraint belt for 24 hours.
7
On 4 April 2014 he signed a document which is in the following terms:
"Advance decision to refuse specified medical treatment
I [his name is inserted] born on [his date of birth is inserted] complete this document to set forth my treatment instructions in the case of my incapacity. I am a Jehovah's Witness and direct that no transfusions of blood or primary blood components (red cells, white cells, plasma or platelets) be administered to me in any circ*mstances, even if my life is at risk. I am prepared to accept diagnostic procedures, such as blood samples for testing."
The document is then signed with what I presume to be his signature and dated "4/4/14" and witnessed by the signature of a named witness bearing the same date, "4/4/14".
8
Yesterday evening, April 2014, he stated that he wanted to get his artery to bleed and began picking again at his wound, despite being under constant observation by staff. He was therefore once again placed in a restraint belt to prevent damage to his artery. According to counsel's note, "When asked about the reason for his self-harming, he has described feeling intense emotions which he can only dampen down by self-harm. Although at times in the past he has said he wishes to die, he does not express any wish to die at the present time. The motivation for his self-harm does not appear to his responsible clinician to be to...
