This case concerns P who had been diagnosed with an Emotionally Unstable Personality Disorder which had resulted in two incidents of self-harm in which the inserting of a tracheostomy tube, led P to attempt to cut her throat. P was given the choice to either keep the tracheostomy tube, reduce and then stop sedation and to undertake training to manage her tracheostomy in the longer term or have the tracheostomy tube removed following which a palliative care plan would be put into effect. A Court of Protection hearing was listed on 12 August 2022.
Background of the case
P has a long history of mental health difficulties and has spent significant periods in psychiatric units since the age of 15. Since 2021 she has had three periods of detention under the Mental Health Act. P has been diagnosed with Emotionally Unstable Personality Disorder, Post Traumatic Stress Disorder and at some points with Psychosis. P has had many incidents of very serious self-harm.
As P had previously tried to remove her tracheostomy tube twice, a decision was to be made as to whether to keep the tracheostomy tube, reduce and then stop sedation and undertake training to manage her tracheostomy in the longer term or have the tracheostomy tube removed following which a palliative care plan would be followed.
Views of P’s Parents and Dr A
When P was calm, she expressed a desire to live and P’s parents explained that this had become a pattern over the years in which P would express her view that she wished for treatment and would then begin self-harming.
P’s doctor (Dr A) explained that P had a psychological need for autonomy and the only realistic hope for P was for her to believe that she was in charge of her own life. Dr A explained that if P believed nobody would intervene to prevent her harming herself, she may not remove the tube. However, this plan could also lead to her death.
Role of the Official Solicitor
An Official Solicitor was enlisted to work on the case because of the difficulties in establishing the degree to which P had capacity and in establishing what her wishes were. The Official Solicitor accepted that the Court should seek to maximise P’s autonomy and that there was little prospect of any long-term recovery from her mental ill-health.
Before a judgement could be made, P sadly passed. However, in the judgment later released, it was stated that it was in P’s best interests, for the care and treatment plan proposed and agreed by all parties to be put in place, accepting that this may lead to her death.
With regards to whether the Court of Protection had jurisdiction on the matter, due to the fact that P lost capacity when she was distressed, the Judge ruled that this was a Court of Protection matter.
The Judge considered the parents views that they believed that the time had come to let P make her own choice which regards to her care. The evidence of Dr A, and P’s parents was that the most important thing for P was a sense of autonomy. This would suggest that continued physical restraint and replacing the tube if she removed it, undermined P’s autonomy and further damaged her mental health. The judge was guided overall by the sense of autonomy for P as restraining her and replacing the tube offered no long-term solution to her physical or mental issues. There was very little, if any, prospect of any long-term improvement to P’s mental health. Therefore, that form of treatment appeared to be futile in anything other than the very short term.