A woman with paranoid schizophrenia will undergo surgery for breast cancer against her wishes after a UK High Court ruled she lacked capacity to make the call on her treatment.
The 66-year-old known as ‘JT’, who was diagnosed with the mental illness 25 years ago and living in the community supported by psychiatric community nurse, believed her breast lump was a cyst and the doctors advising her were actors or imposters.
In a decision in Britain’s Court of Protection, Justice Keehan ordered that it was lawful for the University Hospitals of Midlands NHS Trust to undertake wide local excision of the ductal adenocarcinoma of the woman’s left breast under general anaesthetic.
It was also lawful to administer restraint or deprivation of liberty if necessary to enable the surgery on JT, who may suffer ‘fatal consequences’ without it, Justice Keehan said.
The court heard ‘JT’ was referred to the trust’s breast care services in February 2017 by her GP but missed three appointments.
She attended in June where a malignant lump in her left breast was confirmed by ultrasound and biopsy.
A psychiatrist who had treated her for 18 years told the court ‘JT’ lacked capacity to decide on her treatment.
“Her understanding is that she does not suffer from breast cancer, and it is a conspiracy on the part of her enemies to pretend that she had the illness, so they can enforce some procedure or treatment on her of their own making,” he told the court.
“She believes she had been taken to a fake hospital by a fake impostor brother who was seen by fake doctors and this is all part of a conspiracy. She refused to accept any medication for surgical treatment.
Medicolegal expert Bill Madden told the limbic a court in Australia can make the same kind of the decision using its parens patriae jurisdictional powers.
“For a court to consider such a case, it requires evidence as to the persons capacity (or lack of) and the appropriate treatment.
“The court then makes a decision based on the person’s ‘best interests’.”
Recent examples in Australia include court decisions ordering the termination of a pregnancy for a 12-year-old girl and a blood transfusion on a seven-year-old, against the wishes of the child’s Jehovah’s Witness parents.