Deprivation of Liberty Safeguards: A course for families

By Amanda Hill (previously written as ‘Anna’, daughter of a P)

Update: Following the court changing the Transparency Order for my mum’s case in March 2025, I can now reveal my identity

I’m involved in a Court of Protection s 21A application concerning my mother and the origin of this case was a Deprivation of Liberty Safeguards (DoLS) application.

So when I learnt about this course run by Edge Training specifically for family members of people in care homes and hospitals under DOLS, I was interested in finding out more. 

The day before the course (on 8th December 2022), I received an email containing the Zoom link and a copy of the pack of slides for the course. This proved to be very useful. I had a quick flick through them before the course but I also had the slides on my ipad during the course, which I accessed from my laptop, and of course they will be handy to refer back to in the future. I’ve attended a lot of courses where participants have asked whether the slides will be available afterwards, or I’ve had to take screen shots myself, so I appreciated being sent the slide pack in advance. 

I logged on a couple of minutes before the scheduled start time. Normally you sit in a waiting room but this time I was admitted straight away. I heard soft piano music and saw a couple of slides on rotation, informing participants to get in touch with the administrators if they couldn’t hear anything, or hadn’t received the slides, and information about how to ask questions. I could see other participants had joined too, although all cameras and microphones were off. Overall, I found registration and access to the course very efficient and organized, and helpful for participants. 

The course was led by Aasya Mughal, who started by introducing herself and Edge Training. She explained that Edge Training is a firm that provides legal training, particularly in the field of human rights issues, mainly concerning the health and social care sector but also for other organisations such as the police and the military. The trainers come from a range of professions and include judges, lawyers and social workers. Aasya is a barrister and director of Edge Training. 

I was quite surprised when, after her introduction, Aasya asked participants to introduce themselves and why they had wanted to attend. She stressed that the course was not being recorded and all personal details would be confidential, and she made it clear that people should only speak about what they felt comfortable saying. There were only six participants, and the course is always capped at 20, so this ‘personal’ approach is always possible. Everyone introduced themselves and most people put their cameras on to do this. This set the tone for the course, as it was quite interactive. Aasya encouraged participants to ask questions either through the chat or through raising a virtual hand (cameras stayed off whilst Aasya was going through the slides), and she mostly answered them as they came in. This approach was an alternative to going through all the slides and then having questions at the end, and it worked quite well as it meant the questions were relevant to the information on the slides.  

The content of the course was very informative. It covered the legal background to DoLS, some relevant statistics, what it is and who is concerned, the process, different types, criteria, the role of different professionals, protection and rights for those under DoLS, what can happen if procedures are not followed correctly and some other interesting legal information. 

The content could have been difficult to follow for us lay people attending, but Aasya explained it all in a very easy-to-understand way. And she took the time to explain anything that anybody said they didn’t understand. She made it very accessible. 

From my perspective, I also feel that what added to the value of the course was participants sharing experiences and stories, and in this way, we could learn from each other. This wasn’t “overdone”, it was mainly Aasya talking, and it was done in a safe way so that everybody only said things that they felt comfortable saying. This aspect of the course is dependent on the people who attend, but Aasya’s manner certainly helped:  nobody felt pressurized to speak. Some people had positive experiences of the DoLS process and some more negative and it was helpful to discover different perspectives. 

One thing I came away with is that (as I’ve experienced with my mother) families can feel at sea in relation to DOLS and unsupported. The more knowledge gained, the better the ability to navigate the process. This course would be really beneficial to family members whose loved ones are subject to, or likely to be subject to, a DoLS authorization. Most of the participants on this course were a certain distance along the path but it would definitely be useful for people at the start of the process as well. Aasya answered individual questions where possible or pointed people in the right direction to find out more. 

Aasya explained that more courses for families, like this one, would be run if there is enough interest. I for one would thoroughly recommend it for relevant families and I wish I’d had the opportunity to attend it earlier, at the time when my mum first became subject to a DoLS authorization. It would certainly have helped me to understand the whole process and its implications much more. There are still certain aspects that I don’t fully understand but this was not a bespoke consultation for me and I learnt a lot in a short time. I would encourage any families seeking to understand DoLS more to attend future courses. 

These courses are run regularly, so check out the Edge Training website – where there are free DoLS Rights resources if you need information before then (click here). 

Amanda Hill is a PhD student at the School of Journalism, Media and Culture at Cardiff University. Her research focuses on the Court of Protection, exploring family experiences, media representations and social media activism. She is a core team member of OJCOP. She is also a daughter of a P in a Court of Protection case and has been a Litigant in Person. She is on LinkedIn (here), and also on X as (@AmandaAPHill) and on Bluesky (@AmandaAPHill.bsky.social)

“He deserves a chance”? Continuities and shifts in decision-making about life-sustaining treatment

By Jenny Kitzinger, 14th December 2022

Mr P, an active and relatively healthy middle-aged man, had a heart attack at home on 3 September 2021. 

His family, and then subsequently, paramedics, delivered Cardio Pulmonary Resuscitation [CPR]. This was successful, insofar as he remained alive and his heart was re-started. However, he suffered devastating, irreversible hypoxic brain injuries. He has been left in a prolonged disorder of consciousness [PDoC]. This outcome is sadly not uncommon after CPR, a fact which complicates a general public narrative about CPR successes and ‘saving life’.

The medical evidence (from his clinical team and from two independent experts) is that P is currently completely unaware of himself or his environment and has been for the last 15 months. He is in a ‘vegetative state’ (one of the sub-categories of PDoC). There is a very small chance he might, in future, move into Minimally Conscious State minus, another category under the umbrella term PDoC. This slight shift in his level of (un)consciousness is very unlikely to occur. Even if it does it would, for him, simply involve, as one independent expert described, having the ability to feel pain, for example, but no ability to even distinguish between individuals around him. 

His future is likely to involve further physical deterioration (e.g. infections and increased spasticity). His life-expectancy, if current interventions continue, could be seven years. Meanwhile he is at risk of another heart attack or might die because of his increased risk of respiratory infections.

Mr P had not made an advance decision to refuse treatment or appointed anyone with Lasting Power of Attorney for health and welfare. It is, therefore, in the first instance his clinical team and (now) the judge who must make decisions about which of the medical treatments available to him are in his best interests. 

His clinical team is no longer willing to offer CPR or antibiotics for life-threatening infections.

They are apparently still willing to offer clinically assisted nutrition and hydration (CANH). However, they (and independent experts) do not think such treatment is now in his best interests. Efforts to reach an agreement about this with his family (including via formal mediation) has not succeeded. 

The questions before the court in this case were whether it is in P’s best interests for life sustaining treatment (specifically CANH) to be withdrawn, or not (or as more properly described, whether such treatment should continue to be provided). 

Alongside this, the court was also being asked to decide whether the Trust’s proposed palliative care plan is in his best interests.

I was interested in observing this hearing because I have been researching family experiences of having a relative in a Prolonged Disorder of Consciousness for over a decade now and am co-director, with Celia Kitzinger, of the Coma and Disorders of Consciousness Research Centre. We’ve published widely in this area and contributed to guidelines about the care of PDoC patients from the Royal College of Physicians. We’ve also developed resources for families and online courses to support clinical teams with law, ethics and best interests decision-making.

I have been observing court cases for a long time now – and also providing support to families going through them – so I am also interested in how the law, and the conduct of hearings, has shifted over recent years.

In this blog I describe the efforts by everyone involved to try to work out P’s best interests and specifically what P might want in his current situation. This work was done by family and friends on the one hand, and the clinical team/Trust and the Official Solicitor, on the other. Attempts to determine what he might want built on the same evidence (medical information combined with testimony about P’s values and how he lived his life) but different parties had come to different conclusions.

I conclude by reflecting on how this hearing is situated within the context of changing professional guidance/practice and case law over the last few years (including the ground-breaking Supreme Court judgment in Re Y (An NHS Trust & Ors v Y [2-18] UKSC 46).

Who was who in court

The hearing I observed was on Wednesday 7th December 2022 in the Royal Courts of Justice before Mrs Justice Arbuthnot.

The application was brought by the Trust responsible for P’s care, represented by Ian Brownhill of 39 Essex Chambers. The first respondent was P, represented by his Litigation Friend, the Official Solicitor – the barrister was Nageena Khalique KC of Serjeants’ Inn Chambers. The second respondent was P’s eldest daughter (supported by the rest of P’s family) – she was represented by Ben McCormack of Garden North Chambers.

Written evidence had been provided by P’s family and friends and by P’s clinical team. There were also reports by two independent experts (both Consultants in Neurological Rehabilitation). Professor Derick Wade provided a report in January 2022 and Dr Andrew Hanrahan, a jointly instructed expert, provided another independent report in July 2022.

The medical evidence presented in court

The medical evidence was not contested. Neither of the two independent experts gave oral evidence to the court and there was no cross-questioning or direct challenge to the medical consensus about P’s current state or likely prognosis. The level of certainty about his diagnosis and prognosis seemed compelling, informed by knowledge of the nature of the original incident, evidence from brain scans, the fact that it was now 15 months since the hypoxic injury, and evidence from repeat testing over time.

Hearing from family and friends in court

I think this hearing was originally planned to be entirely ‘in person’; however, in the event, it was actually hybrid (due to difficulties experienced by family members in getting to the Royal Courts of Justice on the day). 

Use of technology ensured effective participation from all parties and from people “engaged in caring for [P] or interested in his welfare” (s.4(7)(3) MCA 2005) e.g. a friend who provided oral testimony by video-link. Mr P’s wife and three daughters (also all on video-link) appeared together from their home, with his eldest daughter taking the lead to represent the family and provide an oral statement about her fatherAlthough patients’ relatives can feel that they should be (or want to be) in the physical courtroom, facilitating the option of online connection can be very valuable. Online access allows  family members to support each other while giving evidence from a familiar environment, and avoids additional time and financial stresses at a point when they are often very overstretched and want to be at the bedside.

Everyone in court was consistently committed to ensuring that information about P as an individual was central to the hearing. When the friend due to give evidence had technological challenges joining the hearing, the court allowed plenty of time (half an hour) for this to be resolved and made a point of appreciating the efforts he had put in to participating once he did establish a connection. When the daughter became upset and faltered giving her testimony, the judge gently suggested that the order of witnesses be changed to allow time for her to compose herself. The judge said she wanted to be sure that P’s daughter would be left with no regrets, and would know that she’d been able to communicate what she wanted to in court. 

A point was also made about sharing photographs of P “in happier times”, before his injury. Although not formally filed, all parties were content for these to be shared and counsel for the family gave these to the clerk to pass on to the judge to look at. 

There also seemed to be a very positive relationship between Ben McCormack and the eldest daughter who he was representing. I hope this, and the general approach from the court, meant that the family felt heard, respected and supported.

Witness statements about P as a person

Oral evidence from the eldest daughter: P’s daughter showed great determination in speaking out about her father and painted a vivid portrait of him. I noticed how (like many of the family members with relatives in PDoC I’ve interviewed), she switched between past and present tense when talking about her father, perhaps revealing a tension between acknowledging the extent of what had been lost alongside recognition of his ongoing physical existence and some hope for his return in some form in the future.

“He was an all-round great dad. We have so many great memories”, she said, “He did anything for anyone – he would give the clothes off his back. He is just a great guy”. It is, she said, “really hard to see him [as he is now].” At which point she faltered and could not go on.

Returning to give evidence later, she started by saying that, whatever his current condition, “His presence now is just as powerful as what it was before”. It was clear that even if entirely unconscious, this man is still very much ‘there’ for the family who visit him daily as the much-loved father and husband he has always been.

During her testimony P’s daughter gave more detail about what kind of person he had been. He was, she said, “a loving soul”, a husband who had (until his cardiac arrest) not spent more than one night away from his wife throughout their long marriage. He was also a father devoted to his children, being sure to make time to collect them from school, and – now some of them are older – collecting them from work too, as the whole family continued to live together. He came across as a father committed to raising strong, resilient and independent offspring. He taught his daughters how to plaster walls, change engine oil, and spray paint cars. “Coming from a mixed-race household”, his daughter added, “ he always made sure we were comfortable in our own skins, and true to ourselves”.

A strong theme in the evidence about P was that he would always want to be with his family. His daughter described an incident at work when he fell off scaffolding and broke his leg. In spite of being in great pain, he insisted on being driven to the hospital closer to his family, rather than the hospital closest to his workplace. “Even though he was going through the worst pain imaginable, he still wanted to be closer to us so we could see him.” Her father, she said, would “always fight to come back to his family”.

Although they did not directly dispute the medical evidence, there was a sense that this family found it hard to reconcile what they were being told about P’s condition and what they experienced when they visited him (a very common challenge for PDoC families). During the process of his assessment, we heard the family had shown assessors a video of him. One clip showed him rapidly blinking, for example, which to them seemed to be in response to instruction, but which the experts assessed as a common spontaneous behaviour. Even on the day of the court hearing, the family wanted the judge to see a video too, of what he had been like the day before. Although the video was not formally submitted as evidence all parties were happy for this to be shared with the judge. (For discussion about the use of family videos in other court cases see, “Seeing is Believing? Patient Videos in Life-Sustaining Treatment Disputes”).

The family also seemed to hope against hope that P might defy the odds. “He was a fighter – there wasn’t anything he couldn’t do’, said his daughter. “All we want is to be given more time, he deserves a chance”…and later “All we want is more time. If there is any chance at all, he’d want to take it, to get back to his family”.

Evidence from a friend: The image of this much-loved man was reinforced by evidence from a close friend. Describing P as “like a brother, more than my own brothers”, the friend told the court how Mr P would “never turn anyone away….the generosity of the man just overwhelms you”. He also had huge physical strength and energy. His friend described moving a piano with P; four people on one side, and P on his own on the other, lifting that side all by himself. Prompted by the family’s barrister to talk more about “inner strength”, this friend also underlined that P had great mental strength and a “willingness to do whatever his family needed from him”. Expressing his own difficulty accepting the medical view he added:

“He’s got his eyes open – not focusing on me, but he lifted his head off the pillow which shocked me. I still think he’s in there, fighting. They tell me it’s just muscle spasms, but I find it hard to believe that when he lifts his head. Knowing the man I do, I believe he’s fighting to come out of that coma.” 

He added “I’d like to see him up and about again, to be with his family. I’d like the court to give him that opportunity”.

None of the barristers had any questions for P’s daughter or his friend. They were simply thanked for giving evidence.

Closing submissions and queries from the judge

In his closing submission Ian Brownhill, for the Trust, emphasised that no amount of medical intervention is going to return Mr P to his family. His future is bleak. He’s at risk of physical deterioration, totally dependent on nursing staff to meet personal needs, and at risk of respiratory infection, which, left untreated, are likely to bring his life to an end. He asked the judge to consider whether Mr P would want to live in his current state or, alternatively, be allowed to die with dignity in a hospice surrounded by the family and friends by whom he is so clearly loved.

The judge had some questions for counsel for the Trust. She asked for confirmation that the only reason P had continued to receive antibiotics last time they seemed to be potentially useful was because the family had at that point agreed to mediation (a few weeks earlier, in November 2022) – “so clinicians decided to treat rather than need an urgent hearing or face an unplanned death for Mr P?’ Ian Brownhill confirmed this was correct. She also asked about the current situation about antibiotics and was told by Ian Brownhill that “He won’t be given antibiotics again”. No court order was needed in relation to antibiotics as the clinicians were not willing to offer antibiotic treatment. A similar situation applied to CPR. 

The judge then asked whether the experts were saying there was “no prospect of recovery at all, is that right?” She was told by Ian Brownhill that, if anything, his condition was worsening. There followed some discussion about ensuring that the palliative care plan (should a decision be made to discontinue CANH) was fine-tuned to address P’s and his family’s needs, especially in relation to religion and culture. The plan had been carefully drawn up and, Ian Brownhill said, met the gold standard of clinical care (as outlined in the Royal College of Physician’s guidance on care in these circumstances). However, the family had felt unable to engage with end-of-life planning so far. The judge wanted to be sure this would now happen and expressed concern about, for example, ensuring that P’s large family could be with him at the end (rather than the practical and covid-informed limit of four visitors in the room at any one time, which was the hospice’s general policy).

The court then moved on to hear the closing submission from Ben McCormack. He underlined the fact that family and friends opposed the Trust’s application to withdraw CANH. They had, he emphasised, conveyed a vivid picture of P and the code and principles by which he lived his life: it was a matter of priority to them that this be considered by the court. He also highlighted that the family accepted the medical facts, but they did want to challenge the suggestion that his muscle tone was worsening; this was not their impression from their experience of helping with physiotherapy for him, and it was important to the family that this point be made. 

Ben McCormack also drew attention to P’s religion: “He was a Muslim who believed only God could choose a time of dying. He wasn’t a regular attender at mosque but would have held himself up to be a practicing Muslim”. He highlighted an extract from a written statement submitted by P’s brother: “He would say to me ‘when your time is up, your time is up, until then you don’t give up, no matter what’”. He also highlighted other statements from family about religion: “taking away nutrition would go against his beliefs” (daughter) and “a vital tenet of his faith is the preservation of life” (wife). 

Ben McCormack asked the judge to give due consideration to P’s possible attitude towards ‘chance’. He acknowledged that doctors are unlikely to go into print definitely stating that there is ‘no chance’ of any change, he agreed that the medical evidence was that even minimal change was “spectacularly unlikely”, but invited the court to consider the fact that the family feel that “even if these prospects are really small, this is a man who can and would want, to fight on”. Mr P was an individual who “doesn’t take no for an answer, whether it’s carrying a piano or manoeuvring a steel joist into a building. His family invite you to ensure those core beliefs are accounted for”. 

During this discussion P’s daughter intervened to raise another concern. She described what the family had experienced when P’s catheter had become blocked and “he’s maybe trying to push the water out. To us that means he can feel pain. So, withdrawing nutrition is a really cruel thing to do to someone”. Clearly the family needed to know how any possible pain would be managed if CANH were withdrawn. The issue of how many members of the family might be able to be present at one time was also raised again by the judge and Ian Brownhill asked his instructing solicitor to step out of court to contact the hospice to raise this question with them.

The final closing submission was from Nageena Khalique KC (acting for P, via the Official Solicitor). She outlined Article 2, the right to life and the strong presumption in favour of preserving life – but this is “not absolute and can be rebutted”. She described how reasonable steps had been taken to prolong P’s life over the 15 months since his heart attack and how the MCA Code of Practice indicates that in a limited number of cases treatment could be futile, overly burdensome with no prospect of recovery. She underlined the need for “anxious scrutiny” of what a treatment can do. In this case, she said, there is “a volume of evidence that treatment is not going to change the condition of Mr P…The most that can be expected from treatment is to fend off the infections, pressure sores and worsening contractures”. Quoting from an expert report she highlighted the clear expert view of “what can be expected for Mr P for the remainder of this life”.

“In practical terms ‘there is no doubt’- I pause there – ‘there is no doubt’ about what will happen for the remainder of his life.” 

The words written by the independent expert, she emphasised were ‘clear and unambiguous’ and ‘very stark’. Mr P will not have any autonomy or ability to control any area of his life. He will, by extension, not be the provider he’s always been. He will not have any functional abilities – even to the level of scratching an itch himself. He won’t be able to interact socially “at any level, even at the level of being able to recognise a particular individual”. This was, Ms Khalique KC surmised, something that, “had he had the opportunity to consider” he would be “extraordinarily distressed about”.

Quoting from a joint statement provided to the court by two of P’s daughters, she drew attention to their view that “We wouldn’t want our dad to live in this condition for the rest of his life, and dad would not want that either. But if there is any chance of recovery, he would want that”. She argued that “The whole basis of which the family would want him to continue is based on the possibility of a miraculous event going against all the medical evidence, that he might improve or recover”. There was, she said, “incontrovertible evidence about fixed and extensive” damage to his brain. Addressing the question of what Mr P might wish for in these circumstances she argued that “while the court may accept he’d want a chance at recovery, the court must forensically examine whether there is, in reality, a chance at all”.

Turning to the question of his religious faith Ms Khalique KC quoted from earlier case law and argued that “Religion may well be integral to character but that should not lead to assumptions that P would have taken a particular theological position based on his religion” and that it is “impossible to know what Mr P’s attitude would have been to life being sustained artificially”.

Finally, she highlighted that there was no evidence that Mr P was deriving any pleasure from existence, but that there were some concerns about the possibility of pain. She concluded that for his dignity and autonomy in his final days, it was right for life-sustaining treatments not to be continued. A palliative care plan which allowed him to die with his family around him was now in his best interests.

The hearing concluded with further discussion of the palliative care plan, some discussion about the Transparency Order, and the statement that the judgment would be handed down on Friday. The judge again thanked the family for giving evidence.

The judgment – Friday 9th December 2022

The judgment was handed down the following Friday morning in open court. (It is not yet publicly available in written form but should be posted soon on The National Archives and I’ll add the link when it appears.)

The oral judgment was given online, and everyone (including the family) joined by video-link. 

Mrs Justice Arbuthnot outlined the legal reasoning behind her decision and declared that it is lawful and in Mr P’s best interests for the treating team (a) not to provide ventilation or life sustaining treatment in the form of CANH, and not to provide CPR, and (b) to provide palliative care. 

In handing down this judgment the judge was careful to acknowledge both the kind of man P had been and the family’s concern. She highlighted P’s daughters’ view that withdrawing life-sustaining treatment might “stop what God has written for our dad”. But she said, “The life sustaining treatment delivered thus far has already interfered with what God has written for their father” – and was at pains to point out: “the time of death has nothing to do with the decision of this court”. After CANH is withdrawn: “nature will take its course”.

Execution of this order was delayed until noon on Tuesday 13th December 2022. This was to allow family to consider whether they wanted to appeal (I understand there won’t be an appeal) and to give them time to meet with the palliative care consultant and input into the palliative care plan if they now feel able to engage with this process. 

Reflections: continuities and shifts over time

Since the landmark Supreme Court case of Re Y in 2018, withdrawal of CANH from patients in a vegetative (or minimally conscious) state no longer requires a court application. 

Before Re Y, there were many court hearings at which clinicians and family agreed that withdrawing CANH was in the person’s best interests, but doctors and palliative care teams were unable to proceed without the approval of the court. The decision in Re Y means that decisions about CANH for PDoC patients now come to court only if there is disagreement about what is in the person’s best interests, or the decision is ‘finely balanced’. 

Clearly this case was in court because of disagreement between clinicians and family, and the bases for that disagreement are very familiar to me. 

Like many other families (including those who eventually – years later – ask for treatment to be withdrawn), the family in this case was holding on to the smallest glimmer of hope to stave off the devastating certainty of loss if their loved one died. Like so many people, they also had a belief that their family member was the one who would defy the odds – he is a ‘fighter’ whose sheer determination will enable him to overcome catastrophic brain injury. They also conveyed their strong sense that the person they knew is still ‘in there’, in the warm and moving body, that looks so different from how one imagines a classic ‘coma’.

The hearing was typical of most hearings I’ve observed in recent years, in that the court’s central focus was on working out what P himself might want in the circumstances. 

Mr P meets all the criteria for the diagnosis of a ‘Permanent Vegetative State’ [PVS] (as defined by the RCP PDoC guidelines). The diagnosis of PVS is one which for various reasons, is less emphasised nowadays, in favour of recognising a continuum of consciousness between absolutely none and the flickering awareness of the minimally conscious state, and combining this with a detailed discussion of prognosis. This is a change that comes with pros and cons in terms of family reactions and understanding (CDoCTraining, “Introducing Prolonged Disorders of Consciousness: Unit 3). In earlier hearings,  the suggestion was sometimes made that someone in PVS has ‘no interests’ (an argument made by the Official Solicitor in the Bland case (Airdale NHS Trust v Bland [1993] AC 789). This point was notable by its absence from this hearing (and I have not heard the ‘no interests’ argument mentioned recently at all in court hearings). At the very least, it was acknowledged that Mr P – even if entirely unconscious – had an interest in the manner of his death, and as a devoted family man, he would care about his family’s experience of his end-of-life care, their future wellbeing and how they might remember him. 

There was also no suggestion that Mr P’s values or statements of beliefs should be anything other than core to the decision. Even though there was no evidence of explicit statements about what he would have wanted in his exact circumstances (and no advance decision) a great deal of thought was put into trying to see things from his potential perspective based on what was known about how he had approached life, his faith, his commitment to his family and the code he lived by. It was clear that this would be given significant weight in the best interests balance sheet. This, of course, was not always the case. In W v M, heard in 2011, the judge stated:

“Given the importance of the sanctity of life, and the fatal consequences of withdrawing treatment, and the absence of an advance decision that complied with the requirements previously specified by the common law and now under statute, it would be in my judgment be [sic] wrong to attach significant weight to those statements made prior to her collapse.

I would be very surprised to see a similar statement in a judgment today, over a decade later.

The other element of this hearing that stood out for me was how well-prepared the case was (at least at this stage in proceedings). It seemed clear that Mr P’s clinical team had taken ownership of their responsibilities in relation to best interests and that they had also sought out independent opinion in a timely manner: the first independent expert report was commissioned within a few months of Mr P’s anoxic injury. All the appropriate evidence was in place for the hearing. Although the judge said it was unfortunate that there may have been a delay in enacting Mr P’s best interests because of the mediation (in November 2022), I thought that must have been a hard judgment call for the clinicians trying to work out the best way forward. 

From what I could deduce from the hearing, the action of clinicians in this case reflected what I have seen since the Supreme Court decision in Re Y – which is that clinical teams are increasingly building up the confidence to take responsibility for going through a full best interests process and making every effort rigorously to adhere to the (very clear) RCP and BMA guidelines. It was also good in this case to see explicit statement from clinicians that some treatments were simply not on offer (something which has been more ambiguous in other hearings I’ve observed, where clinicians seem to say that they do not think they should offer a treatment, but would if the judge decides it is in P’s best interests to do so).

Finally, what was evident in this hearing, and I have increasingly observed in other best interests decision-making discussions (both inside and outside the courts) was adherence to the principle that CANH should be treated in law as a life-sustaining treatment like any other and subject to the same best interests processes (as is spelt out by the BMA/RCP guidelines). Alongside this, there seemed to an acceptance that death following CANH-withdrawal might even be preferable to death from, for example, an untreated infection. This can seem counter-intuitive, and certainly challenges the popular discourse around ‘dehydrating and starving to death’ but the suggestions that this can be a relatively ‘good death’ is something supported by family reports to us (see Deaths after feeding-tube withdrawal from patients in vegetative and minimally conscious states: A qualitative study of family experience;  see also CDoC Training: ‘End-of-Life care course: Unit 4, ‘Positive experiences’).

Evidence that death following discontinuation of CANH can be relatively peaceful is also supported by clinical experience. Lynne Turner-Stokes and her colleagues published an invaluable review of ‘experience and lessons’ from the last eight years of decision-making about life-sustaining treatment for PDoC patients in their care. They note that: 

“However sensitively managed, BI discussions regarding elective CANH withdrawal can be very difficult for families, and they require support in their own right. Nevertheless, the feedback from families has been very positive with many expressions of gratitude to the team for supporting a dignified and peaceful death…our experience has been that dying in this situation has often been more peaceful than dying a respiratory death.” 

Understanding of Prolonged Disorders of Consciousness, the care of patients, support for their families, and the law around treatment decisions has undergone rapid evolution over the last decade. Clear monitoring and auditing of patient pathways and decision-making about (dis)continuing life-sustaining treatments is needed, both in the courts and in the clinic, but it seems to me there have been positive developments. I think Mr P’s family can be confident that a huge amount of skill, care, time and experience has gone in to trying to make the right decision, or ‘the least worst’ decisions, in the tragic circumstances in which he, and they, now find themselves. 

Jenny Kitzinger is Professor of Communications Research at Cardiff School of Journalism, Media and Culture. She also co-directs (with Professor Celia Kitzinger) the Coma and Disorders of Consciousness Research Centre and runs online training for healthcare professionals about law and ethics. She tweets @JennyKitzinger

Researching the Court of Protection: Accessing hearings as a PhD student

By Rhiannon Snaith, 9th December 2022 

I’m starting a PhD looking at the media reporting of Court of Protection decisions about life-sustaining treatment. I’m lucky enough to have an ESRC scholarship to do this work, under the supervision of Professor Jenny Kitzinger at Cardiff University. 

As part of my project, I obviously want to study hearings, understand how journalists have access to and negotiate what they can say about a case and look at published judgments, as well as press and TV coverage. 

I hope my work will be useful to the Court of Protection, all those involved in court cases, and to journalists. I also hope it will contribute to open justice principles and to general public understanding of the work of the court

In this blog I want to reflect on the experience of trying to observe a hearing as part of my PhD – and ask for help with this study!

I initially heard about the CoP case (COP 13938884) at around 10pm the night before the hearing was due to happen (on 7th December 2022). It was listed for 10am the next morning before Mrs Justice Arbuthnot at the Royal Courts of Justice (RCJ). It was only at this point that I learned that the case concerned life-sustaining treatment. The court listing did not indicate the subject matter of the hearing (I understand that hearings in the Royal Courts of Justice – unlike COP hearings in the regional courts – never do) – but Celia Kitzinger (co-director of the Open Justice Court of Protection project) had asked on twitter and been informed that it concerned withdrawal of clinically assisted nutrition and hydration. 

At this stage I didn’t know whether there would be an opportunity to view the hearing remotely (it was not listed as remote or hybrid), but as that was the only option for me, it was worth trying to see if online access was possible. So, following the example my supervisor had sent, I emailed the RCJ to request a link to observe the hearing, and cancelled all my appointments for the next day, keeping my fingers crossed I could join virtually.

Preferably, such cases would be good to observe in person but due to the last-minute nature and the fact that a journey to the RCJ would take me up to 5 hours, an online hearing was more feasible. However, I was pleased to learn that a public observer who lived in London was able to get to the RCJ at short notice and we’d be able to have a conversation with him afterward too.

The next morning, I grabbed a quick breakfast, rallied up anything that might be needed including pen, paper, snacks, water etc. and began checking for a link and scrolling through the tips and ‘what to expect’ emails my supervisor had sent me to help prepare for the upcoming observation (if we managed to get in). 

The general rules were to ensure your mic and camera were off, though there is always a possibility that you could be asked to turn them on, which is why it is important to make sure you are appropriately dressed. It is also important to never take any photographs, videos, or voice recordings of the hearing and I was advised not to make any public comment about the case. (Jenny and Celia have live-tweeted from CoP hearings in the past, but Jenny was clear with me that this involved greater skill and understanding than I currently have.). You must also be on your own while observing (unless you’ve previously asked the court for the link to be shared with someone else) and you must not share the link to the hearing with anyone.

Jenny also reminded me that due to the nature of the cases brought to the Court of Protection, it’s important to take care of yourself and take a break, if necessary, at any point during the hearing. However, she advised, it would be best not to exit the video-platform, as there is no guarantee you will be let back in.

The hearing was scheduled to start at 10am, but the link to the hearing did not come through to me until 10.16am. I promptly followed the link and the instructions that came along with it and entered the online conference room. In preparation, I had already ensured that my camera was not only ‘off’ but covered with a sticker and was obsessively trying to check that my mic had been turned off – it was. 

Once I entered the video conference, I was greeted by a black screen that stated ‘No one is presenting’ with a list of names on the lefthand side that told me who was a guest and who was a host: among them I recognised Jenny’s name. Satisfied that we had both made it into the online room, we privately messaged each other (via text message, during which time we ensured our cameras were off and that we were on mute.

Halfway through this exchange Jenny tried to help me by describing which barrister was which by reference to where they were sitting on the benches, as she explained that there had been no introductions (or if there were, we were both admitted too late to hear them). Up until this point I had been under the impression that the hearing had been delayed and I was merely waiting for it to start – but because of her comments I realised Jenny could see and hear things I couldn’t. 

Though I’d followed all the instructions and used the Google Chrome extension, which is recommended, I’d somehow ended up in some sort of holding pen, unaware that the case has started. I exited the online room and attempted to follow the link again – it worked this time and let me straight into the hearing. At this point it was 10.44am so I was really worried that I had missed a lot. But actually, the hearing had been put on hold due to technical problems on the part of one of the witnesses. I was unsure as to who was who, but Jenny thankfully knew some information, even without having heard an introduction herself (e.g., she knew who the barristers were and who they were representing) and she emailed me this and a summary of the bits I’d missed, which made deducing what was going on much easier. I don’t think the hearing would have made as much sense to me without this help. Also, it would have been really helpful to have had position statements, but I gather these weren’t yet available because of issues with the Transparency Order.

At the end of the hearing, the journalist physically present in the court room, Brian Farmer, asked a series of questions about what he could and could not report about the case. This was something he particularly needed to clarify as there was no Transparency Order available. This was really interesting – potentially – and important for my research but I strained to hear what he said as Mr Farmer was, unfortunately, off-mike. The camera was only on the judge at this point, and I had to try to deduce what the journalist was asking from the Judge’s responses.

During the hearing, I began making notes, attempting at first to be consistent with including time stamps (to allow Jenny and me to compare notes easily and to ensure I knew how much time was given to different witnesses etc). Unfortunately, I soon forgot about using time codes in my haste to write up as much as possible, as accurately as possible. In future, I need to find a way to remind myself to jot down the time every 2 minutes or so. This would be beneficial as later, whilst going through our notes, had I put more of the times down both myself and Jenny would know where to go in our notes to compare. 

I made sure that I made both a summary of what was being said (and by whom) and made a note of specific quotes that stood out to me. Following the proceedings was fairly straightforward though, inevitably, there were terms and phrases that I did not recognise or took me a moment to place. I have a growing list of ‘Key Terms’ in a separate document to aid me with this and have researched key aspects of the Mental Capacity Act 2005 which spell out how best interests decisions should be made.

I did find the case itself was upsetting, not surprising for a case where there is disagreement about life-sustaining treatment, but I debriefed with Jenny, and it did seem like the case was well run and the family had a voice. It was good to get a strong sense of the patient, and the lovely and much-loved man he had been, and to feel he was at the centre of the case. 

The hearing was concluded fairly quickly, ending at roughly 12.50pm.  The judgment is on Friday this week, which I also hope to attend. Meanwhile, I’m looking for the media coverage. 

I felt very privileged to have been able to observe this court hearing – but it was only through luck and with a lot of help that I was able to do so, and parts were rather frustrating, from the point of view of a researcher.

A final disappointment was to learn that the Open Justice colleague who’d been going to attend in person, didn’t do so.  He’d arrived at the court room to find a notice on the door saying “Private: No Admittance” and had left the building as a result.   

I can see it is going to be hard to study CoP hearings about life-sustaining treatment – time-consuming and tricky. 

If anyone can help me learn about hearings about life-sustaining treatment in advance, I’d be very grateful, as I hope to attend some hearings in person, and to be able to observe others online.

Rhiannon Snaith has an ESRC PhD scholarship to study reporting of End-of-Life Decisions. She’s just started tweeting @Rhiannon_Snaith and is looking forward to joining in online discussion of law, ethics, end-of-life and the role of journalism. 

Observing a remote hearing in court with the judge

By Celia Kitzinger, 7th December 2022

It was listed as an in-person hearing (COP 13641809) at First Avenue House in London on 28th November 2022.

I was in London for a conference and had the afternoon free, so I thought I would take advantage of the (for me, rare) opportunity to observe an in-person hearing. 

On arrival at First Avenue House (after putting my backpack through the X-ray scanner, phone and lap top out, emptying my pockets and taking a sip from my water bottle), I took the lift up to the 5th floor where the Court of Protection sits.

Court staff greeted me and said the hearing had been “rejigged as a Teams meeting”.  I asked how this would work: should I go away again and find somewhere quiet to sit and watch it via the Teams link?  No.  I would be shown into the courtroom, where Her Honour Judge Hilder would be sitting, and watch her interacting with the lawyers, who would all be attending online, visible on a big screen.

And that’s what happened.

There was a bit of a delay starting, which I think was occasioned by the need to produce a Transparency Order. 

It later transpired that the hearing had originally been expected to be “private” (in which case it had been incorrectly listed).  

We are sitting in private”, said Nicola Kohn, counsel for the local authority. (I wasn’t sure, during the hearing,  who was counsel for which party because, although the judge did a generally very helpful opening summary, it didn’t include which barrister was acting for which party. I’ve subsequently received a copy of Nicola Kohn’s position statement  – thank you! –  which is enormously helpful.)

Since Professor Kitzinger has taken the trouble to come to court,” said HHJ Hilder, “I made a Transparency Order and we are sitting in public”.  And, “just to clarify,” added the judge (turning to address me) “you would have been welcome to attend if it had been a private hearing”. 

It was a slightly surreal experience to be the only person in an otherwise almost empty courtroom, seated opposite the judge and a member of the court staff (an usher? a clerk?).

Normally, observers sit at the back of the court, and even though I knew there wouldn’t be any lawyers in the courtroom today, I somehow couldn’t bring myself to sit on the front benches, in the seats they would normally occupy.  Sitting several rows back was a mistake though – I couldn’t see the screen very well, or read the names of the lawyers on screen. Ironically, I’d have had better access to the hearing if I’d attended remotely like everyone else. With hindsight, I should have asked for the link and could have had it open on my laptop on silent: I’ve done that before – and since! – in hybrid hearings when I’ve been attending in person, and it massively improves the experience.

My engagement with the judge felt slightly awkward too.  Although there was no instruction to “All rise!” as is usual in in-person hearings, I did what the lawyers do in courtrooms and stood up when she entered at the beginning of the hearing – and again at the end when she left.  (This standing-up thing is not practised in remote hearings.)  

I expect the experience of having me in court was slightly odd for the judge too!

The judge introduced the hearing by explaining that KD (the person at the centre of the case) is 18, autistic, and has severe learning disabilities. He does not communicate verbally. He has previously been found to lack capacity to make all relevant decisions.  He lived with his parents until their relationship broke down, and then with his grandmother until being the subject of a care order.  He’s been living in a registered children’s home  – but he’s no longer a child and the focus of the proceedings has been to identify a suitable adult placement for him.  

The last hearing was on 20th October 2022 at which concerns were expressed about the lack of progress and non-compliance with orders.  

The judge had ordered that the next hearing should be listed as “in person”, meaning the legal team from the Bolton area would need to travel to London for the hearing,  “unless the parties could agree that progress had been made and non-compliance issues sorted so as to make attendance in person not necessary”.  And that, said the judge “was only confirmed this morning”.  

Nicola Kohn said there had been “a good deal of cooperation between the applicant and those instructed on [KD’s] behalf”, including a Round Table Meeting “as a result of which the Official Solicitor was satisfied that issues of non-compliance were resolved” – and a subsequent meeting had led to an agreed draft order that was now before the court. 

The judge said she was “fundamentally concerned with the lack of progress in finding KD an adult placement”, since it looked as though nothing would be available until he turned 20.

That was still the case, but the current placement was apparently content to keep him until then – although the judge asked for confirmation of this in writing.

This matter has remained before the court (rather than progressed as part of the streamlined process) owing to the court’s concerns as to KD’s vulnerability and the need for careful planning of his transition to adult care. 

I’m not satisfied it’s appropriate for an adult to remain in a children’s home,” she said, as she tried to explore what was being done to locate an alternative placement – checking whether all placement options, including single tenancy (something that had caused concern previously because of the risk of social isolation), were being checked out. 

There was also some overview of arrangements for KD to go to his grandparents for (unsupervised) overnight visits. They needed appropriate training and to learn about KD’s routines. 

The grandmother wanted to be joined as a party, but the judge asked: “would the needs of the proceedings be better met by inviting [the grandparents] to attend and share documents, without formally joining them as parties, with the risks as to costs” – and that’s what was decided. (It appears they had been joined previously and were discharged, due to lack of engagement.)

The judge also raised questions about the use of a harness – which the grandparents say they never use, but it may be that the placement uses it (that was unclear) and the judge asked for “specific dates as to if and when it has been used since 1st July 2022” and “the learning disability nurse’s view as to its future use”.  

The next hearing will be remote at 11am on 7th March 2022.

This turned out to be a salutary opportunity for me to experience a “judge’s eye view” of a remote hearing.  I can now better appreciate the somewhat isolating and disjointed experience it creates for the decision-maker sitting in the nearly empty courtroom. My thanks to HHJ Hilder for admitting me.

Celia Kitzinger is co-director (with Gillian Loomes-Quinn) of the Open Justice Court of Protection Project. She tweets @KitzingerCelia

“It will all work out”: The limits of a positive attitude in the Court of Protection

By Upeka de Silva and Jemma Woodley, 6th December 2022

We work with Compassion in Dying, a national charity that supports people to make their own decisions about end-of-life care in line with the Mental Capacity Act 2005. 

We promote the rights of capacitous people to document their care preferences using Advance Statements, Advance Decisions to Refuse Treatment and/or Lasting Powers of Attorney for Health and Welfare. 

Recently, we launched a call for guidance on voluntarily stopping eating and drinking at the end of life and so we were keen to observe a case that would potentially address this theme.

Celia Kitzinger alerted me to the case (COP 14017521 Re: EJ, 1st December 2022, Before Sir Jonathan Cohen in the Royal Courts of Justice), having observed the directions hearing last week. Without this, based simply on the Court Listings, I would not have been aware that this matter was before the Court. 

The hearing concerned EJ, a 27-year-old woman who has been diagnosed with rapidly deteriorating Functional Neurological Disorder, which has resulted in her currently suffering from functional quadriplegia and an inability to swallow food and drink. EJ has had contact with psychiatric services since (at least) 2018.  She has a working diagnosis of “Mixed Personality Disorder”, has auditory hallucinations, and her mood dysregulation has raised suspicions of complex Post Traumatic Stress Disorder. She’s been an inpatient in hospital since April 2022, having walked into A&E on crutches, complaining of weakness in her limbs. 

In August 2022, EJ lost the ability to swallow and has been receiving nutrition, hydration and medication through a Naso-Gastric tube (“NG tube”) and/or hydration and (some) medications via a PICC line (an intravenous line).  

Since the end of October, EJ has consistently objected to the NG tube and regularly chews through them or dislodges them by violently shaking her head. 

The Trust has applied for a declaration that it is in EJ’s best interests to have a PEG ( a percutaneous gastrostomy) placed under general anaesthetic, to deliver nutrition and hydration (and medications) directly into her stomach.

The judge, Sir Jonathan Cohen, had to consider the following:

  • Capacity: Whether EJ had capacity to conduct these proceedings and to consent to the provision of treatment including clinically assisted hydration, nutrition and medication
  • Best interests: Whether it is in EJ’s best interests to receive clinically assisted nutrition and hydration, and if so whether this should be via NG tubes (as before) or whether she should have surgery to insert a PEG.

Our first experience of being in the presence of P

EJ appeared in Court, from hospital, by video link. We were pleased that she was part of the proceedings but were soon disappointed to realise that other than her own statement, the only witnesses were clinicians. No family members or friends were called. While we have no doubt that the clinicians sought to keep EJ at the heart of their deliberations, we felt anxious about the potential power imbalance.

While it was useful that the cross examinations were undertaken, not just for the benefit of the judge but for EJ too, on many occasions we felt uncomfortable about EJ hearing fairly blunt descriptions of her behaviour (calling a doctor a “robot”) and making claims relevant to her mental capacity to make treatment decisions (e.g. not understanding that she will die).

We don’t know much about P

Ironically, while it was the first time we had observed a case with P directly involved in court proceedings, it was also the first time that we left feeling we knew very little about who she was and what mattered to her. We learned a lot about the pros and cons of various mechanisms for artificial nutrition and hydration but we don’t know what quality of life means to EJ, or what her wishes, feelings, values and beliefs are.

What we do know is based on what she said, quite forthrightly after all the other witnesses had spoken:

“This whole thing is just bullshit. People don’t listen. Surely, I should get to choose happens to me.”

“I want to represent myself. Even Ted Bundy got to represent himself in court and he was a serial killer.”

“I am articulate and I have capacity spilling out of me. 

Yes, I did call that woman a robot. I’m sorry about that. (To the consultant) You  just spoke a bit robotically at the time. This is a waste of everyone’s time. Everyone has made up their minds already.”

“I don’t want a PEG. I don’t want an NG tube, thank you. Or a PICC line. I want to go home, ideally today. It will all work out – its about a positive attitude – fake it till you make it.”[1]

When EJ spoke, via video link, she clearly expressed a wish to go home and it left us wondering if more could have been done to explore and/or accommodate this wish. At Compassion in Dying we have become very familiar with the desires of individuals to remain in their own homes and avoid going into hospital. While this is not always possible, an honest conversation around this is always appreciated by the people we support. So while the issue for the court was centred around the insertion of a tube, we couldn’t help but feel great frustration for EJ as this strong desire to go home seemed to be overlooked in the deliberations. 

The judgment

As EJ had been unable to demonstrate that she understood the consequences of refusing treatment (that it would lead to her death) and as she also has impairments in the functioning of her mind or brain, she was found not to have capacity to refuse the NG tube or PEG or other medical treatments.

Sir Jonathan Cohen considered carefully that the PEG may lead to short term trauma and a further erosion of EJ’s trust of professionals, but the alternative is death and EJ does not want to die. Rather she remains positive that “things will work out” and so the presumption in favour of life-sustaining treatment weighed heavily in the judge’s considerations.  He found insertion of a PEG to be in her best interests. 

During the judgment, the main screen visible to me as a remote observer was EJ’s. For this, I was grateful, because seeing how she felt mattered to me greatly. I watched EJ nodding approvingly as she listened to the judge repeat her words in his judgment. However, as soon as he authorised the insertion of the PEG, she asked the nurses with her to help her leave the room.

Although deeply apologetic once it was brought to his attention by one of the barristers, the judge misstated EJ’s name multiple times during the judgment which (the barrister reported) caused her much distress. We fear this only added to EJ’s distrust of professionals involved and her belief that the outcome had already been decided before the hearing began. 

On the other hand, we felt optimistic about EJ’s future when the judge ordered that the case should be back in court (before him) for a review in a few months time. He said, given that EJ is “strongly opposed” to the course of action he has ordered, “I think the court owes it to P to consider the matter”. Will EJ adapt to her life with a PEG? Will the medications she’ll be receiving through it help with her psychiatric illness? Will she be retraumatised and feeling defeated? We worry about counting on resilience and psychiatric medication to make up for the loss of autonomy.

Reflections

At Compassion in Dying, we support thousands of people to complete Advance Decisions to Refuse Treatment. The people we support tell us how relieved they feel knowing that these documented wishes matter, clinically and legally. In this way, the Mental Capacity Act 2005 is incredibly empowering. 

When we support people to plan for their end-of-life care, we strongly recommend that they spend time explaining who they are as individuals and what quality of life means to them. Observing cases in the Court of Protection has reinforced how important this is for ensuring that decisions are truly person-centred. 

So, we both struggled today. We didn’t know what truly mattered to EJ.  We heard her objecting in no uncertain terms to the treatment being proposed but we don’t know why she felt this way. We understood that the risk of withholding artificial nutrition and hydration could be death, but hearing from the Consultant Neurologist that another person in a similar situation didn’t need a PEG made us question whether there was no other way to more closely align treatment with EJ’s preferences. 

We appreciate that it would be very difficult for clinicians and judges to take a path that would put EJ’s life at risk. Yet, the trauma of her autonomy being overruled, and the loss of trust in professionals and in her own agency are not insignificant considerations. 

The complexity of decision-making in this case reminded us of how important it is to never over-simplify matters relating to treatment and care, life and death. 

Upeka de Silva is the Policy and Advocacy Officer at Compassion in Dying and tweets @de_upeka

Jemma Woodley is Information Support Officer at Compassion in Dying and tweets @JemmaWoodley2

Compassion in Dying tweets @AGoodDeath


[1] Quotes based on contemporaneous notes as recording is not allowed. They are as accurate as I could make them but unlikely to be 100% verbatim.

Hoarding disorder, dementia and a wish to return home

Celia Kitzinger, 5th December 2022

This is the fifth Court of Protection case I’ve observed about someone with hoarding disorder. (Take a look at my previous blog post: “A case of hoarding” which describes plans to return a person home with safeguards in place to keep her safe.)

The woman at the centre of the case I’m reporting on today is 82 years old, with both dementia and a hoarding disorder,

She’s now in a care home under an urgent order which expires in two days’ time, and she wants to return home.

The case (COP 14017786) was heard remotely before Mrs Justice Morgan, sitting in the Royal Courts of Justice on 22nd November 2022.

Until October 2022 she’d lived in a care home, but then decided to return to her home – which was “dilapidated and in a dangerous state”. 

She was thought to have the capacity to make this (clearly unwise) decision, and the local authority worked with her to try to keep her as safe as possible.

Everything came to a crescendo last Thursday with a (third) forced entry into her home, due to a smell of gas.  She’s been using a butane gas cylinder to cook on.

She was admitted to hospital to be assessed for gas poisoning and made it clear that when she was discharged she would return home.

The local authority made an urgent out-of-hours application to convey her to a care home on discharge. That was approved and she was discharged from hospital last Friday to a care home where she is reported to be “relatively settled, but is clear that she would like to return home”.  It turns out that’s not going to happen (if it happens at all) before the end of January 2023.

Both lawyers (one for the protected party, one for the local authority) emphasised that she is “very articulate” and that “the capacity issue is not straightforward”.  

What’s needed now is a capacity assessment from an independent expert to determine whether or not she has capacity to make this decision for herself.  Counsel had hoped to appoint Professor Paul Salkovskis from Oxford Health NHS Foundation Trust who runs a national specialist clinic for hoarding and had been instructed in another case of hoarding earlier this year, Re: AC and GC (Capacity: Hoarding: Best Interests[2022] EWCOP 39. But it seems as though he’s not available and they hadn’t yet located another expert

The case in which Professor Salkovskis was instructed earlier this year had some very similar features. it concerned a 92-year-old woman referred to as “AC”, also with both dementia and hoarding disorder.  She had been moved to a respite placement whilst the poor sanitary conditions and other hazards identified by professionals (including electricians and the fire services) were dealt with and she clearly and consistently expressed the wish to return home.  The judge in that case authorised a trial for AC to try living at home.  I don’t know how it worked out – but it was clear from the agreed statement of legal principles in that case law is very much on the side of honouring, where possible, a protected party’s wishes to live at home.  This extract is from Appendix 3 of Re AC)

In Re GC [2008] EWHC 3402 (Fam), Hedley J considered whether it was in the best interests of an elderly man to be discharged from hospital to the home where he had lived for many years and commented at para 21: 

‘GC is a man in the 83rd year of his life and my concern is to ask myself: how will he most comfortably and happily spend the last years that are available to him?…. Next it seems to me that for the elderly there is often an importance in place which is not generally recognised by others; not only the physical place but also the relational structure that is associated with a place …’

In connection with the issue of a ‘trial’ placement, Hedley J commented at para 24:

‘It seems to me that it would be wrong not to try, even with a degree of pessimism, a placement with a package of support’

The decision of District Judge Eldergill in Westminster City Council v Manuela Sykes [2014] EWCOP B9 is of relevance:

‘several last months of freedom in one’s own home at the end of one’s life is worth having for many people with serious progressive illnesses, even if it comes at a cost of some distress. If a trial is not attempted now the reality is that she will never again have the opportunity to live in her own home’

and that

‘although there is a significant risk that a home care package at home will ‘fail’, there is also a significant risk that institutional care will ‘fail’ in this sense (that is, produce an outcome that is less than ideal and does not resolve all significant existing concerns)’

Mr Justice Hedley held in P v M (Vulnerable Adult) [2011] 2 F.L.R. 1375, at para [34]:

“I am very influenced, rightly or wrongly, but it is only right everyone should know it, by the timescales in the case. I am very influenced by the desire to allow people where it is at all possible to spend their end time within the family rather than in an institution, even if there are shortcomings in terms of care which an institution could address.” 

Where (as here) there are serious risks attached to returning home, the court has:

“…confirmed that its function in challenges such as this can be to take decisions on behalf of P that public authorities feel are too risky for them properly to be able to take themselves, and that it is perfectly appropriate that responsibility for the outcome should fall on the shoulders of the court (Re M (Best Interests: Deprivation of Liberty) [2013] EWCOP 3456, Peter Jackson J (as he was then) at para 41)”. (Appendix 3, Agreed Statement of Legal Principles, Re. AC & GC)

I hope the 82-year-old in this case will have the opportunity to try living at home again, with the right support in place.  It may be, of course, that she has capacity to make that decision for herself. 

The next hearing – at which these matters will be decided –  will be on (or around) 30th January 2023 at First Avenue House, London.

Celia Kitzinger is co-director (with Gill Loomes-Quinn) of the Open Justice Court of Protection Project.  She tweets @kitzingercelia

Note: The facts of this case are as accurate as I could make them on the basis of the hearing (which included a helpful opening summary). However I have not received Position Statements from either party, nor have I received a Transparency Order, despite my requests.

“I don’t want to be here… I want to go home”

By Catalia Griffiths, 2nd December 2022

I am an assistant psychologist working with Older People at Bensham hospital in Gateshead. Claire Martin is my line manager. On my first induction day with Claire, she mentioned that, outside of work, she is a member of the core group of the Open Justice Court of Protection Project. I remember being amazed, thinking about how passionate she must be about promoting open justice in the Court of Protection to carve out time on her days off for it.

Since our first chat about the project, I had been looking forward to observing my first Court of Protection case. I finally got the opportunity on Monday 7th November 2022 at 10:30am – a remote hearing before DDJ Reeder (COP 1399280T) sitting at First Avenue House.

I remember the rush of emotions waiting to receive an invitational link to the virtual courtroom. I was simultaneously nervous and excited, unable to sit still at my desk. 

The email arrived, and attached to the link was a ‘Transparency Order’ document. Unsure of what it was, I clicked the file and my stomach sunk as the realisation set in. It was a document with a set of rules that must be obeyed around observing the Court of Protection case. Any defiance meant that you may be “sent to prison, fined” or have your “assets seized”. Although I was not planning on disobeying any of the rules, the formality and the authority of the document invoked a sense of fear in me. It reminded me a lot like being in the presence of a police officer. Although you know that you are not doing anything wrong, you cannot help but feel a little bit nervous around them. 

When Claire and I were let into the virtual courtroom, we were asked to turn on our cameras and to state who we were. Judge Reeder was happy for us to sit and observe the case: he even offered us 5 minutes of his time at the end to answer any questions (which is an extremely rare occasion). 

As soon as the case began, I remember feeling overwhelmed. As there was no round of introductions. I was trying to work out who was who, whilst also listening to Judge Reeder giving a brief summary of the case. It felt like I was trying to jump onto a fast-moving train. 

From the summary given by the judge, I gathered that the protected party (referred to as “GNK”) was an inpatient with Huntington’s disease. Her case was brought to the Court of Protection because her wishes are to be discharged from the hospital and go back into the comfort of her own home. 

The case first came to court on 24th October 2022. At that point, the judge said that she “awaited the consideration of a litigation friend. I reviewed that she lacked capacity to conduct litigation, based on [treating doctor’s] report.” The COP3 form from the Social Worker supported this view. 

The judge went on to set the context further: 

JudgeBy that time an authorisation had happened regarding residence on the ward until 16th January 2023. We then constituted proceedings on the basis of Section 21a challenge – GNK said cogently “I don’t want to be here.” So, if so, when and to where? GNK said “I want to go home”. The Local Authority took the view that this wasn’t suitable, and …. discharge planning hadn’t reached a conclusion. We moved to highlighting two things – my concern that what was being talked about was a refusal by GNK to acknowledge her Huntington’s disease and a refusal to acknowledge the need for care. I asked [whether it was] lack of capacity or an unwise decision wanting to go home and look after herself. The other thing is [the] transition. I highlighted that for authority for chemical or physical restraint – I would expect the plan to detail clearly levels of escalation, triggers and the contents of each level, and the personnel involved at each level. [Then it was] relisted urgently for this hearing. 

I thought this was an important question from the judge: is GNK’s wish to move back home evidence of her making capacitous ‘unwise’ decisions or does she lack the capacity to understand, retain, weigh and communicate the relevant information in relation to this decision? The judge has requested a section 49 report from the Trust, hoping that this question will be answered. A future hearing has been arranged for the 29th January 2022 to address the issue. 

Judge Reeder also pointed out that although the option of GNK moving back home is not yet closed off, her services do not seem to be doing everything in their power to make it a more feasible option. For instance, making sure that her home is habitable, since it has been reported that the home is “significantly hoarded” and “not safe to get into”. They are also unaware of what kind of tenancy it is or what bills need to be paid in order for GNK to move back in. Judge Reeder mentioned that it would be pointless to send her home only for it to be repossessed within a few months. I agreed with his point, and wondered why her team was not doing everything they could to explore whether they could honour her wishes. 

Whilst the possibility of GMK moving back home is properly explored, there is the possibility that she might be discharged to an interim placement. The judge spent time questioning the draft order which outlined a transition plan, should she need to move somewhere in the meantime. He was especially concerned about the triggers for escalation to different levels, given that the draft order is requesting authorisation for physical and medical restraint. 

Judge: The thing I can’t see very clearly is the triggers to move between the levels of escalation. It starts with encouragement. I am reading for the first time … it’s written in a narrative. You’ll appreciate I understand that this is on the basis that restriction is necessary but it helps me to understand how those involved with P would move between these levels of escalation. 

Louise Thomson (counsel for the Local Authority): They don’t want to use any kind of restraint. It’s hoped that verbal encouragement and reassurance will reduce the need … if she actively resists then minimum restraint will be used on her limbs and a belt in the chair. I can’t see how it will be escalated further.

Judge: I can see one starts with verbal encouragement, then escalates to ‘physical assistance’ and then it reads that this may then be followed by physical restraint. I have to say it could still be a little bit clearer. The different trigger points for escalation. I can see work has been done to address the levels – I can see the contents of each level to a degree but I can’t see the trigger points. I appreciate it’s a difficult situation but for the court to authorise it I need to see the triggers to escalate the levels. It’s where we get to ‘restraint’ or ‘further restraint’. Please give it a bit more thought to make it clear. The reason I say this is because if it’s not clear to me, it may not be clear to others on the ground. 

Coming from a support worker background, where I have had to use physical and mechanical restraints on patients, I thought this was a necessary request from the judge. Using restraint is a serious process that can have a significant impact on patients and, in some cases, can result in re-traumatisation. Due to this, it is crucial to have a clear explanation of what the draft order refers as “triggers” to escalate the levels from “encouragement and reassurance” to “physical assistance” to “further restraint”. An unclear care plan can lead to unnecessary or unsuccessful use of restraint. A clear care plan will help “others on the ground” i.e. support workers or nursing staff, to work collaboratively and efficiently, minimising inappropriate use of restraint and therefore minimising distress and injuries to both P and staff during the transition.

As the hearing went on, I remember shifting my attention to GNK. She lay there quietly on her hospital bed, and you could tell that she was listening intently to everything that was being said. I remember thinking about how she might feel about being discussed in great detail in front of numerous professionals as well as two observers that she had never set eyes on. At that moment, I felt a sense of guilt; I wondered if she was informed beforehand that we would be there, and if not, should she have been asked if she was happy with it before the hearing began. I felt like I would have been more comfortable in knowing that she was comfortable with us observing. 

Judge Reeder concluded that GNK should be discharged to a place where she can “live with comfort and where her needs can be met”. Before the final decision can be made, as well as detailed escalation triggers for physical restraint, Judge Reeder has asked GNK’s services to explore what needs to be done to consider the option of GNK moving back home, including contacting her wider family members to see if they are “willing to help with property clearance”. 

Although very patient, Judge Reeder was clear that more efforts were needed: 

Judge: It would be unfortunate that if nothing has been done, it was repossessed. What I am trying to say is that you need to tweak the order – urgent effort needs to go into contacting the landlord, finding out about the tenancy, finding out about arrears and the basis on which landlord has sought possession and whether they intend to proceed with that. It would be unfortunate if it [GNK’s home] disappears by default whilst we are dealing with case management. Please give that some thought. [Judge’s emphasis]

Judge Reeder asked to speak directly to GNK herself. 

Judge: There’s a suggestion, GNK that you and I speak in due course, prior to me making any decisions about where you should live in the longer term. Is there anything you want to say now to me now? 

GNK mentioned that she does not know what people were referring to by the condition of her flat, and that any issues with the flat was supposed to be sorted by the property owner. 

Judge: We will have a really good look at your home to see if it’s okay to go back there. This is a temporary move whilst we make decisions about going forward. 

Although it was brief, I was glad that the judge spoke directly to GNK, asking if she had anything to say to him. At first it made me wonder, with Huntington’s disease having an impact on cognitive skills, how well she was able to understand and follow the entire hearing. However, from GNK’s question about the condition of her flat, it was clear that she was at least able to grasp a rough idea of what was being discussed. I was relieved by this as I could not imagine what it would feel like to hear your name being brought up but not understand the details that were being discussed. 

Although it was a shame that we did not get to hear more about GNK as a person, I did find the case extremely interesting and exhilarating. Having worked in inpatient services, I enjoyed looking at mental capacity from another perspective. It sparked my interest in a person’s mental capacity and how such a complex concept can be assessed. It made me query the reliability of mental capacity assessments. I aim to further my knowledge on the area, and hope to observe a mental capacity assessment being completed.

Catalia Griffiths is an Assistant Psychologist, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust. She is based with Claire Martin in the Older People’s Clinical Psychology Department, Gateshead.

Note: Quotations are based on contemporaneous notes and are as accurate as possible but unlikely to be completely verbatim, as audio-recording is not permitted.

Coercive and controlling behaviour continuing after brain injury: Matters of finance and contact

By Joanna Booth, 30th November 2022

The person at the centre of this case (PB) is a 65-old woman who had a brain haemorrhage in 2018. This was so severe that it left her with a lasting brain injury and significantly impaired cognitive functions and since leaving hospital she’s been looked after in a specialist care home. She’s been found to lack capacity to determine her own residence, care, and contact, and to conduct proceedings.

 At an earlier hearing, her husband (MB) had been found to exhibit a pattern of controlling and coercive behaviour towards her. This had been a pattern of their marriage before her brain injury, and continued after she was admitted to full-time care – along with his overbearing and aggressive behaviour towards the care home staff.

The hearing I observed (via MS Team) on Wednesday 23rd November 2022 (COP 13615665) before Sir Jonathan Cohen sitting in the Royal Courts of Justice was to consider (again) matters of contact between husband and wife, and also how her financial affairs should be managed.

PB was represented in this hearing (via the Official Solicitor) by Mary-Rachel McCabe of Doughty Street Chambers. The Health Board was represented by Benjamin Tankel of 39 Essex Chambers. The local authority was represented by Rebecca Jayne Blackwood and MB (PB’s husband) was represented by James Holmes of Garden Court Chambers. 

Background to the hearing

Since April 2019, when PB was discharged from hospital, she has lived in a specialist care home where she receives a significant package of care that she is likely to require for the rest of her life. She is subject to a standard authorisation depriving her of her liberty at the care home.

From the early days of P’s admission to hospital in 2018, safeguarding concerns have been raised in respect of her husband (MB’s) conduct towards her and there have been, throughout, significant concerns about his “combative approach” to the medical professionals involved in P’s care. 

On 5 February 2020 it was alleged that MB had inappropriately touched PB in a sexual manner.  Soon afterwards COVID-19 restrictions were imposed on contact with care home residents and from 3 April 2020 the decision was taken to restrict MB’s contact with PB to 2 video calls per week.

In June 2020 MB commenced proceedings seeking an order that it was in the best interests of his wife to return to the family home and reside with him and that the contact restrictions were not in her best interests.

There have been several hearings already in this case.  In April 2021, Francis J made an order that contact between  PB and her husband (MB) should be severely restricted.  He made an injunction prohibiting MB from having direct contact with P and from entering or approaching the care home and severely restricting communication with any care home staff.

The last hearing was in February 2022 before Sir Jonathan Cohen, and the judgment was published on 15 March 2022, as MB v PB & Ors [2022] EWCOP 14.

His judgment covers both the ‘fact finding’ element of the proceedings and also his decisions on best interests.

He found (§61 of the judgment)

i)                   That there was a pattern of controlling and coercive behaviour before P’s admission into full-time care.

ii)                 That there was a pattern of coercive and controlling behaviour that continued after her admission into full-time care.

iii)               That MB has a controlling and overbearing attitude towards the care staff. 

iv)               That MB has sought to interfere in the provision of care by his refusal to accept what professionals tell him and his insistence that he knows best about what care P should be receiving.

v)                  That MB has sought to limit and control the contact that P has had with other members of the family particularly her children and her sister.

vi)               That at times P has found contact with MB to be upsetting and unwelcome.  Equally at other times she has derived pleasure from it.

The judge found that “the single most important factor in this case is to maintain P’s position in the care home.  There is no other venue in Wales that is felt able to meet her needs. Nothing would be worse for her than for the home to feel that it could no longer keep her because of the pressures and disruption created by MB.  If the choice is between MB’s contact with P and the maintenance of the home, the latter must prevail” (§66).  

But he was “concerned that the loss or cessation of all contact between P and MB may not be in her best interests” (§67) and asked the parties to consider “a trial period of contact over a number of visits whereby P’s reaction to the resumption of contact could be assessed, along with MB’s ability to comply with the restrictions required and the contract of expectations which he must sign up to”.  (§69)

The judge said he would “hold a further hearing when the parties have had the opportunity to consider this judgment”.

That was the hearing I observed.

Hearing on 23rd November 2022

The Health Board’s position was that  two  key issues needed to be determined: (1) Property and Financial Affairs Does PB have  capacity to manage her own financial affairs? If not, what steps should be taken in respect of the management of PB’s finances; and (2) Contact between PB and her husband MB. I’ll address each in turn.

Issue 1: Property and financial affairs

PB’s husband believes that she has capacity to make her own decisions about property and finance.  The Health Board’s position is that she does not have capacity to do so. Due to this disagreement, the court directed the Health Board to obtain an independent assessment, which was now before the court. 

It was reported in court that the finding was that PB has limited abilities in relation to communication.  She can utter single words but not always in an understandable order. She has severe word-finding issues. 

She has trouble understanding where in time or place she is. She struggles with complex information. She can understand basic information about food choices or what clothes to wear. 

During her assessment she struggled with recall. She has severe memory problems. 

The clinical psychiatrist tried to discuss house and property issues with her. 

She couldn’t tell him why she was at the care home or how long she had been there. She was asked about when she’d last been to her home and she said four months ago. It had actually been four years previously. She was unable to say where she was or why she was there. She did not know how her care was paid for. 

The MCA sets out a 2-stage test of capacity: 

First: 

….  a person is unable to make a decision for himself if he is unable—

(a) to understand the information relevant to the decision,

(b) to retain that information,

(c) to use or weigh that information as part of the process of making the decision, or

(d) to communicate his decision (whether by talking, using sign language or any other means).

(s. 3(1) MCA)

Second: A person can only be found to lack  capacity to make a decision if their inability to do so is “because of an impairment of, or a disturbance in the functioning of, the mind or brain” ( s.2(1) MCA)

The Health Board’s position is that PB is unable to make her own financial decisions .Due to her brain injury, she cannot understand or retain, use, and weigh the information she is given. She can communicate but her answers are so variable that they cannot be relied upon. 

Therefore, the Health Board’s position is that a deputy be assigned to PB, to manage her financial matters. 

Counsel for PB’s husband argued that a deputy is unnecessary because her husband is already her DWP-appointed appointee. The Mental Capacity Act code of practice, s.8.36 specified that when a person has benefits but no property or assets, then an appointee can be assigned to them, which is within the remit of the DWP.

The local authority lawyer, Rebecca Blackwood, stated that PB does have property. It was also relevant that in the Judge’s previous hearing, reported in March, MB was found to be coercive and controlling. It would therefore be entirely inappropriate for MB to be kept or put in control of PB’s finances, in line with that ruling. 

The judge went on to state that it was plain that MB would not be an appropriate deputy for a wide number of reasons. There is also a conflict of interest: the funds that PB receives for her PIP are mixed in with MB’s finances and used to pay for utilities and the mortgage for the house they jointly own. 

Also, said the judge, the court does not have the power to appoint appointees; that is only for the DWP. The court only has power to determine the appointment of deputies. 

There were also issues with MB’s current control of PB’s finances. At the previous hearing, in February 2022, the court ordered MB to provide some money (a ‘fund’ or ‘float’ of £200 for PB so that additional items could be provided without having to rely on communicating with him. This system of having to ask MB for every payment required for PB was seen to be at one extreme a continuation of the coercive and controlling behaviour towards his wife, and at the other, unwieldy. He did not provide this fund until October of this year, seven months later. 

Issue 2: Contact

PB has been in the nursing home for four years. While indirect contact (video-calls) had been organised with the nursing home, there was no direct contact face-to-face after an injunction had been issued against MB. 

The indirect contact between the couple was to be facilitated once a week by a nursing assessor provided by the Health Board. 

The nursing or caring staff at the nursing home could not be used to facilitate contact because the home had refused contact with MB after his abusive behaviour. 

MB also requested through his team that when virtual meeting could not be held, that they were rearranged so they could still happen. 

The Health Board said they would look into it but could not guarantee it.

The court was looking at facilitating direct contact in other ways. MB had requested a list of conditions to be met and if he could meet them, then he requested direct contact. The conditions included finding a suitable care agency that would be able, with Health board approval, to facilitate a meeting. 

The judge felt it was important to at least attempt direct face-to-face contact. He suggested it was very worrying that a wife and husband had been separated for a long time and could not see each other.

It doesn’t seem right that contact is forbidden if a suitable nurse can be found,” said Sir Jonathan Cohen.

The Health Board representative pointed out that there were huge obstacles in the way and they were mostly due to MB. 

He said, if conditions can be met, there would still be residual concerns as to whether direct contact would be in PB’s best interests. 

The meeting would be better in the garden of the nursing home where if she is fatigued or if there are concerns, she can leave quickly. In the community, where MB wants the meeting to be held, this would not be as easy. 

Also, in the seven months since MB proposed the conditions to be met, he has not found or looked for a suitable care agency, and the Health Board have not been able to find one either. 

There would be lots of stresses for this type of package, which would consist of an hour or half an hour a month. The carer would not have the knowledge of PB to understand, perhaps, when she was showing signs of distress and needed to be removed from the meeting. 

The judge stated that he did not underestimate the difficulties to surmount the hurdles. But if the conditions can be met then some dates in March or later in the spring should be provided, where PB could be wrapped up in the garden on a sunny, dry day, for a meeting. 

If a deputy is appointed, and the thresholds are met, then the care agency costs would be decided by the deputy. 

A best interest declaration by the deputy would be required, claimed the Health Board.

The judge stated that contact would be a good use of funds. 

The Health Board stated that the nurse assessor used for the virtual meetings would be available indefinitely subject to resource. 

The judge asked whether the nurse assessor could be used for the direct contact.

The Health Board replied that they were not willing to make the nurse assessor available for direct contact. MB had been found to target members of staff with hostile behaviour. MB does not accept the findings of the previous hearing and insists that everyone is out to get him. The Health Board is not willing to expose the nurse assessor to his behaviour. 

Judgment

The judge found that PB does not have capacity to manage her own financial affairs and ordered that the local authority should appoint a panel deputy 

In relation to contact, if  MB can identify a suitable care agency, with Health Board approval, and if MB pays for it, then arrangements for contact will be made and a date found in spring, when there’s better weather, so that PB could meet with her husband MB in the garden of the nursing home. 

For indirect contact, if virtual meetings can’t take place at the assigned time, then the meeting will be reorganised for another possible time. 

There are no orders for these matters to come back to court unless circumstances change.

Joanna Booth is a freelance journalist who writes at joannab.substack.com. She studied law, politics, and social research methods, and worked for years as a social researcher in higher education organisations. She works as a journalist, and is studying towards a PhD by publication on local media and political participation. She tweets as @stillawake.

Decision-making with clarity and compassion: Validity of LPAs and appointment of Deputy

By Clare Fuller, 28th November 2022

As a consultant for Lasting Power of Attorney and an advocate for Advance Care Planning, learning more about the Court of Protection work and processes is important to me. I have attended previous hearings and found the experiences invaluable[i].

This hearing concerned whether the person at the centre of the case had validly appointed his sister and her husband with Power of Attorney. 

Lasting Power of Attorney (LPA) is a legal document that enables a someone to nominate a trusted person to speak for them if they ever lose capacity due to ill health or a sudden accident. There are two different LPAs, one for Health and Welfare and one for Property and Finance.

The key questions in this hearing were: (a) were the LPAs valid and (b) if not should a Financial Deputy be appointed and if so who?

I’ve written previously about “Capacity to make a Lasting Power of Attorney”.  In essence, an LPA is only valid if it is made when a person has capacity:

“To work out whether someone lacks the mental capacity to make a decision, you need to answer ‘yes’ to these two questions: Do they have a mental or brain problem that stops their brain or mind from working properly? Is that problem causing them such difficulty now that they are unable to make this particular decision at the time it needs to be made? Being ‘unable to make this particular decision’ means that the person can’t: understand relevant information about the decision that needs making; keep that information in their mind long enough to make the decision; weigh up the information in order to make the decision; or  communicate their decision – this could be by talking, using sign language, pictures or even just squeezing a hand or blinking.”
LP12 Make and register your lasting power of attorney: a guide

In a key case earlier this year concerning capacity to make an LPA (The Public Guardian v RI & Ors [2022] EWCOP 22 ), the judge helpfully laid out the relevant information that a person needs to be able to understand, retain and weigh if they have capacity.  This information is:

a. The effect of the LPA.

b. Who the attorneys are.

c. The scope of the attorneys’ powers and that the MCA 2005 restricts the exercise of their powers.

d. When the attorneys can exercise those powers, including the need for the LPA to be executed before it is effective.

e. The scope of the assets the attorneys can deal with under the LPA.

f. The power of the donor to revoke the LPA when he has capacity to do so.

g. The pros and cons of executing the particular LPA and of not doing so.

There are two parts to this blog. I’ll first consider issues of access and transparency as they impacted on me as a member of the public seeking to observe a COP hearing, and then (in the second part) I’ll consider the substantive issues before the court.

1. Transparency

On this occasion I was also mindful of the Open Justice Court of Protection work on assessing the performance of the Court of Protection which you can see listed below and read more about here

Before I describe the hearing and what I understood and learned from attending, I will briefly reflect on the ten KPIs identified and can report:

  1. The hearing was listed on @CourtServe.
  2. It was not clear the public could observe.
  3. Partially met, the hearing was remote but the information did not clarify it was by telephone not video link.
  4. Correct contact information supplied on CourtServe and on the First Avenue House websites (and reproduced by the Open Justice Court of Protection Project).
  5. Fully met, I understood the hearing was about decisions relating to Lasting Power of Attorney (see listing below). 
  6. Fully met, it was listed as a “Directions” hearing (see listing below).
  7. Fully met – I received a link to join the meeting via telephone.
  8. Not met.  I did not receive a Transparency Order.  I am basing this blog on my understanding of the ‘standard’ transparency order from previous experience at the Court of Protection hearings.
  9. Fully met, the opening statement by the judge provide clarity on the case, introduced the parties and identified who was representing whom. 
  10. I requested but did not receive a Position Statement (i.e. a statement from the parties which setting out their argument and what they want the judge to do).

I’ll now describe what happened before and during the hearing and what I learned from being present. I’m including the “before” to show how straight forward it can be to attend and what to do – things I wasn’t aware of before my first experiences as an observer.

Before the hearing

I was made aware of the hearing the night before and was able to access the following information from Open Justice Court of Protection Twitter; knowing I had an interest I was lucky enough to receive a direct message alerting me to the hearing, and pasting in the entry from the Daily Cause List for First Avenue House.

Using wording from a previous template I applied via email; I am including the email which can be used and adapted for anyone wishing to attend a hearing.  It’s important to put the words “Observer Request” and the case number and judge’s name in the subject header of the email.  This is because staff are busy and it’s helpful to make it as clear as possible what you are asking for.

At 09:38 I received an email informing me of the dial-in details to attend the telephone hearing. I had previously joined by video conference before, so joining by telephone was new to me; I read that the landline was free to use – however there could be charges associated with using my mobile phone. 

2. The Hearing

Opening 

The hearing began at 10:34 with a welcome from Deputy District Judge Whitfield. There were two other people in attendance (aside from the judge and me):  these were the applicant from East Riding Council (who I will anonymise as Mr Jones), and the respondent who I will anonymise as Mrs Lucy Smith. 

Mrs Smith’s husband (anonymised as Thomas Smith) was noted by the judge to be a co-respondent but currently in hospital and therefore unable to attend.   Judge Whitefield commented that information had been jointly received from Mr and Mrs Smith and confirmed it was acceptable to continue in his absence. Judge Whitfield explained that Lucy and Thomas were attorneys for Steven (the person at the centre of the case, Lucy’s brother)  both for Health and Welfare and for Property and Finance.

The judge proceeded to explain the formalities of the hearing –  namely that it was being recorded and that each of us could state we were in a private location and could not be overheard or disturbed. He asked if it would be acceptable to use first names in his discussions with Mrs Smith, to which she agreed; I will therefore continue in the blog with first names for Lucy and Thomas. The judge suggested it helped to reduce the formality which I understood, however I also felt it could have been appropriate to use first names for everyone rather than the respondents only for greater equality. Neither Mr Jones from East Riding Council nor I were referred to in first name terms, maybe a discussion on this potential power in balance is material for another blog?

Before formally embarking on the hearing, Deputy District Judge Whitfield asked how Thomas was and said that he hoped Thomas continued to make good progress in hospital. I had the impression this was valued by Lucy and it certainly helped create a compassionate atmosphere. 

The questions to answer

The key questions in this hearing were: (a) were the LPAs valid? and (b) if not should a Financial Deputy be appointed and, if so, who?

Deputy District Judge Whitfield proceeded to lay out a summary of the issues at the heart of the hearing.  (Providing this kind of summary meets KPI 8.) I found this helpful and appreciated having the background explained in such a clear manner. He explained that the hearing concerned the “validity of various LPAs and whether a deputyship should be appointed”. He outlined Steven’s history describing him as “approaching sixty, living in rented accommodation and as a person who has experienced lifelong physical and learning disabilities”. 

The judge continued to explain that Steven has made two Lasting Power of Attorney documents (one for Health and Welfare, one for Property and Finance) which were signed in May 2022 but not yet registered due to objections raised by East Riding Council. 

Following a capacity assessment made last year, Steven was identified as having a “basic idea of money”, but no ability to weigh up decisions or communicate with insight. 

Both East Riding Council, represented by Mr Jones, and the two prospective attorneys had previously believed they should act for Steven and indeed that he wished them to.  Deputy District Judge Whitfield noted that Steven is reported to have tendencies leading him to be “easily led” and to provide the answers that he believed to be wanted.

A previous dispute resolution meeting had been held and the judge stated he understood that Lucy and Thomas no longer objected to East Riding Council’s application.

In summary (said the judge):

  • Were the Lasting Power of Attorney documents valid when they were signed?
  • Would an investigation be required? (This would “fall away” if there were no longer objections)
  • Does Steven have capacity to make a Lasting Power of Attorney?

Lucy and Thomas’s historical “lack of confidence” for the Council’s management of Steven’s financial affairs was identified, followed by a hope they were now satisfied “it is appropriate, and in Steven’s best interests, that East Riding take over financial affairs”.

The judge explained there was nothing to preclude “all parties discussing affairs” and suggested “establishing a baseline for discussing Steven’s needs, for example, Christmas presents and winter clothing”. 

Having established that Steven does not have capacity to make an LPA, deputyship was described as a way of protect Steven and anybody else from misunderstandings. I have written in detail about the differences between an attorney and a deputy in an earlier blog and summarise briefly below:

  • CAPACITY: An LPA is made when a person has capacity, a deputyship is made if a person has lost capacity
  • CHOICE: Making an LPA gives a person choice in who can speak for them, a deputy is appointed by a court
  • PROCESS: It is more complex to apply for a deputyship than an LPA
  • TIME: It takes around twenty weeks to set up an LPA; a deputyship takes considerably longer
  • COST: It is more expensive to set up a deputyship compared to an LPA
  • ONGOING COST: There is an ongoing annual cost associated with a deputyship whereas an LPA has a one-off registration cost.

At this point, the judge asked Lucy if she and Thomas would be content that East Riding looked after Steven’s affairs to which Lucy agreed saying, “I only want what’s best for Steven”.

I noted that Deputy District Judge Whitfield stressed there was no “suggestion of impropriety”, and stated to Lucy “I suspect you have a lot on your hands”. This continued to demonstrate compassion that had been displayed earlier in the hearing. 

The formal outcome

The judge summarised the proceedings stating “I formally record the LPAs are invalid and should not be registered, and the application for deputyship for property and affairs is approved”. 

The LPAs were invalid was because Stephen lacked capacity at the time of signing the documents. 

The unexpected outcome

In opening the hearing,  Deputy District Judge Whitfield set out the relevant details. It appeared clear that the issue of Steven’s lack of capacity had already been agreed, this meant that Stephen would require a person (or persons) to manage his financial affairs.  As Steven is unable to make an LPA, a deputyship is required for him; once again this was agreed by all parties at the outset. Following initial disagreement between East Riding Council and Lucy and Thomas, I understood in the opening statement that this had been resolved:  both the respondents were now happy for East Riding Council to act for Steven.

At the outset the hearing appeared straightforward, and whilst the formal outcome was no surprise to me, what I had not expected was to see a Judge checking on a respondent’s welfare. 

I have referred twice already to the compassion shown by Judge Whitfield and this continued to the end of the hearing.

Judge Whitfield gently and sensitively asked Lucy about how she was coping and what support she was receiving.  On hearing that Lucy was coping without help he stated, “you might be entitled to some help and support yourself as his (Thomas’s) carer. Can you signpost Mr Jones?”   To which Mr Jones stated, “I am happy to talk to Lucy after this call.”

What I learned from observing

This was the fifth time I have attended a hearing through the Open Justice Court of Protection project and built on the previous knowledge and confidence I have gained. I know that both information received beforehand and the application process can vary and fully appreciate the drive to set KPIs as minimum standards. As a new observer it can be easy to believe that you somehow “don’t know” how to navigate the system when instead the system is not clear enough to navigate. This is sad because any barriers to attending could dissuade people from attending and work against the judicial aspiration of transparency.

I left the hearing with greater confidence in how to navigate the system, but more importantly, with great respect for seeing compassion in action.

Clare Fuller RGN MSc is a registered nurse with a career dedicated to Palliative and End of Life Care. She is an advocate for proactive Advance Care Planning and provides  EoLC Service Analysis and bespoke EoLC Education. Clare hosts Conversations About Advance Care Planning. She is also a  Lasting Power of Attorney Consultant and director of Speak for Me LPA. Connect with Clare on Twitter @ClareFuller17


[i] Previous hearings I’ve blogged about are: 

Bearing Witness: Anorexia Nervosa and NG Feeding

Lasting Power of Attorney: Across Borders

Capacity to make a Lasting Power of Attorney

Reflecting on Re MW and Advance Planning: Legal frameworks and why they matter  

What happens when Lasting Power of Attorney goes wrong?

Closed Hearings: Submission to the Rules Committee

By Celia Kitzinger, 22 November 2022

Preamble

There’s a sub-committee of the Court of Protection Rules Committee looking at the matter of closed hearings. ‘Closed hearings’ means hearings where one party (and their legal representatives) is excluded by order of the court and may not be told the hearing is even taking place – as happened to the mother in the ‘covert medication’ case we’ve blogged earlier (e.g. Reflections on open justice and transparency in the light of Re A (Covert Medication: Closed Proceedings) [2022] EWCOP 44). There are also ‘closed material’ hearings where some of the evidence before the court is withheld from one party (and/or their legal representatives).

The sub-committee is composed of four barristers who do a lot of work in the Court of Protection: Alex Ruck-Keene KC (Hon), Fiona Paterson, Joseph O’Brien KC and Michael Mylonas KC. Joseph O’Brien was also involved in Re A (the closed hearing case we blogged about earlier) as the legal representative for the Trust.

The subcommittee is preparing a report so as to enable the Vice-President to issue Practice Guidance about what must be taken into account when closed hearings are considered. I was invited to make a submission. What follows is that submission, as sent to the committee on 21st November 2022.

Submission on Closed Hearings by Celia Kitzinger

I am writing this submission in a personal capacity as a member of the public. I draw on my experience of observing 370 Court of Protection hearings as a public observer, and most particularly on my experience of the case of Re. A (Covert Medication and Closed Hearings) [2022] EWCOP 44  (henceforth Re A) – of necessity, because that is my most extensive (and concerning) experience of observing proceedings of which I know closed hearings to have been a part.  Although I draw also on my experience as co-director of two groups (the ‘Open Justice Court of Protection Project’ and the ‘Coma and Disorders of Consciousness Research Centre’), the views expressed here are my own, except when otherwise attributed.

In the aftermath of Poole J’s decision to reveal the fact of the closed hearings in Re A, I have done some research on closed proceedings and ‘closed material’ hearings. I have read relevant case law[1] and also the guidance from 39 Essex Chambers relating to “Without notice hearings before the Court of Protection” (November 2017). I have raised concerns about the role of observers in relation to closed proceedings in four different regional Court of Protection User Group meetings and I’ve benefitted from the responses from lawyers and judges. I have also discussed closed hearings with around two dozen Court of Protection lawyers and with family members of people involved in Court of Protection proceedings.  In trying to get to grips with the ethics of closed hearings – and specifically the ethics of what happened in Re A – I’ve also read some moral philosophy on truth-telling and deception. 

Obviously, what I’ve written here may reflect errors in my understanding of law and practice in the Court of Protection. This is an opinion from an informed ‘outsider’ (not a lawyer) and should be read with that in mind.  I apologise for anything that sounds naïve or insulting or just plain wrong. I’ve done my best to be a ‘critical friend’ to the Court.

The key points of my submission (explicated below) are as follows:

1. Reactions to Re A (both from lawyers and from the public) clearly demonstrate the need for guidance on closed hearings– and it needs to be outward-facing.

2. Guidance needs to explain the exceptional circumstances under which judges can discard the ordinary rules of judicial enquiry – with concrete examples drawn from case law, and illustrating ‘good’ and ‘bad’ practice in decision-making about closed hearings.

3.  There should be reporting and monitoring of closed proceedings and closed material hearings.

4. Closed hearings should be listed as such and open, in principle, to observers.

5.  The Guidance should say that judgments from closed hearings should normally be published on publicly available sites (e.g., National Archives).

6.  Guidance needs to deal with how to manage open hearings running in parallel with closed hearings – ideally by stating that this shouldn’t happen (certainly not over periods of months or years).

7.  The Guidance should address (and encourage lawyers and judges to address) moral complexity – in particular, the moral costs associated with making the right decision. 

8.  The Guidance should state that observers must not be admitted to ‘fake’ hearings (if they continue to happen) without proper briefing.

9. The Guidance should emphasise the need to inform the excluded party about closed proceedings as soon as possible (not least, to enable an appeal).

10.  Some remaining issues….

1. Reactions to Re A (both from lawyers and from the public) clearly demonstrate the need for guidance on closed hearings– and it needs to be outward-facing

Before my involvement in Re. A, I did not really understand  – and nor, it seems did some COP lawyers – that there were ‘closed’ proceedings (as distinct from merely ‘private’ ones) in the Court of Protection.  It had not occurred to me that parties might be deliberately excluded from hearings by court order, or that it could ever be fair and just to do this. The events of Re A therefore came as a shock – and as a learning experience. In retrospect, it seems as though I should have known about closed hearings, since there is case law publicly available – but I had not stumbled upon it, nor had I fully appreciated the import of some judicial comments to which I’d been exposed which (now) I recognise as referring to closed hearings.  The different terminologies used (‘without notice’, ex parte, closed material proceedings, etc) has acted as a barrier for me in making sense of it all.  Since some lawyers, as well as members of the public, tell me they were unaware of closed hearings (in the sense intended by this subcommittee),  it would be helpful for Guidance to flag up that closed proceedings (as defined in the subcommittee’s terms of reference) are a part, albeit an exceptional part, of Court of Protection practice.

The polarised reactions from lawyers to the events revealed in Poole J’s judgment in Re A also clearly demonstrate the need for Guidance. Some lawyers  – those not previously aware of closed hearings – saw the closed hearings as unethical, insupportable and even unlawful. One COP lawyer described the events in Re A as “breath-taking“: “Managing a case in this way,” he wrote, “requires either total ignorance or total disregard for our most basic constitutional principles”.  Another lawyer wrote: “Serious questions raised about open justice, of course. But this is surely an Article 6 violation. The party excluded from the closed proceedings litigated from *a place of ignorance engineered by the court*”.  

Other lawyers appeared to minimise what had happened.  Some compared the exclusion of A’s mother from the closed hearings to s.49 orders or to disclosure orders against GPs (the relevant comparison being that those organisations/people are also often not in court when orders are made against them). Some pointed to the ‘successful outcome’ of the proceedings as offering total justification for everything that was done along the way.  

Others spoke of “discomfort” and feeling “uneasy” or “queasy” about events in Re A without being able fully to articulate why – in one case, despite the experience of having been involved in what the lawyer described as a “wholly justified”decision to hold a closed hearing enabling P to be transferred from an abusive partner to a place of safety.  

Formal Guidance would provide lawyers (and judges) with a scaffolding of facts, law and relevant considerations to take into account when engaging with closed hearings in future. It would enable them to: identify the conditions under which closed hearings are lawful and necessary; prevent too easy an acceptance of the need for closed hearings; and encourage reflection on the challenges presented by closed hearings and how to manage them.

There is also a clear need for the Guidance to address the concerns of members of the public (including people involved in COP proceedings). 

There are two broad aspects to public concern with closed hearings: (1) the procedural irregularity involved in excluding a party (often a family member) from the proceedings; and (2) the substantive outcome of the hearing in terms of declarations and orders made, which can be perceived as unfair or even as human rights violations. 

These two concerns are inter-related because there can be a perception that an outcome perceived as unjust has come about as a consequence of closed proceedings, i.e. that if there had been a ‘fair’ hearing at which the excluded party had been able to participate (tell their ‘side of the story’, cross-examine witnesses etc)  the judge would have made a different decision.  

In addition, the Re A case in particular has raised (or underscored) public concerns about practices seen as involving ‘deception’ – both by lawyers and by the judiciary.  This arises in particular from the fact that, in April 2022, there was an open hearing before HHJ Moir (with a public observer) at which A’s mother was left in ignorance of highly salient decisions made in an earlier closed hearing – decisions which impacted upon her application in the open hearing. 

The mother applied for her daughter to return home in part on the grounds that professionals had failed to get A to agree to hormone medication and that she (the mother) would be more likely to be able to do so in the home environment[2]. This was also the gist of her application in the hearing before Poole J. Both applications were based on false premises. Having been told that her daughter was still refusing hormone treatment, she assumed (as I believe she was meant to assume, and as her legal team and the public observer also assumed) that her daughter was not receiving hormone treatment. Her position statement claims for example that “at 23 years old, [A] has not attained puberty” (§4) and that “[A] is not taking her endocrine medication, her future remains at risk…” (§12) (Position statement for A’s mother dated 16 September 2022).

At the April 2022 hearing, all other parties, and the judge, knew that the mother’s assumptions that her daughter had not received hormone medication and had not gone through puberty were not true. They did not correct her. 

The mother and her legal team were not told that A had been covertly medicated, or that she had gone through puberty, until the first day of the open hearing in September 2022. 

As a result of learning the true facts at the beginning of the September 2022 hearing, counsel for the mother described the mother’s position statement as “otiose” (i.e., as serving no practical purpose, lacking effect, pointless, useless, futile) and the mother reluctantly withdrew her application for her daughter to return home. 

Up until that point, information had been kept from her such that she participated in an open hearing not knowing about the closed hearings from which she’d been excluded and not knowing material facts about the case. 

Learning about this episode is very disturbing for family members currently involved in Court of Protection cases.  It raises the question “could something like this be happening to us?”.  

It would be helpful for the Guidance to consider ways in which the taint of deception could be removed, as far as possible, from cases involving closed hearings and to recognise and seek to minimise the moral injury they can cause.  By ‘moral injury’ I mean the experience of “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” and “may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially[3].

I hope those who produce the Guidance will – in selecting its language and content  – take account of the fact that members of the public are likely to read it.  While not addressed to us, it should be written in the knowledge that we are part of its audience, and that our understanding of what it says is likely to influence our confidence in the Court going forward.

2. Guidance needs to explain the exceptional circumstances under which judges can discard the ordinary rules of judicial enquiry – with concrete examples drawn from case law, and illustrating ‘good’ and ‘bad’ practice in decision-making about closed hearings 

The Guidance should reiterate that the fundamental principles of judicial inquiry ordinarily demand that all parties are able to participate in proceedings, and that justice should be done openly at a fair hearing, on the basis of evidence made known to all parties. 

This will reassure the public.  

It will also serve as a useful alert to some lawyers.  I’ve been alarmed by the apparent readiness of some of those with whom I’ve discussed Re A to advocate for departure from the ordinary principles of judicial inquiry in order to achieve the ‘right’ outcome without (in my view) sufficient consideration of alternative courses of action or of the moral costs associated with closed hearings. 

The Guidance needs to reference the Court of Protection rules that permit the court to exclude parties from hearings, and to withhold evidence from parties – highlighting that this can only be done where it serves the overriding objective of promoting P’s best interests in circumstances where  “justice would be defeated if notice were given” (§5 COP PD 10B).  

The Guidance should explain the sorts of circumstances under which closed hearings are permitted (or required), making clear the burden of justification lies with those who claim that these ordinary principles of judicial enquiry do not, in the particular circumstances of the case, serve the ends of justice and should be discarded (paraphrased from Lord Devlin in Official Solicitor v K [1965] AC 201 (p. 238)).

Concrete case studies should be included in the Guidance. It would be helpful to include cases where closed hearings were considered and rejected, as well as those where closed hearings went ahead. It should also include those where closed hearings resulted in bad decisions (e.g. the case of Aamir Mazhar[4]) as well as those where closed hearings were clearly the right thing to do and led to positive outcomes.

3.  There should be reporting and monitoring of closed proceedings and closed material hearings 

The Vice President has said that closed hearings are  “extraordinarily rare[5], but nobody seems able to provide information about exactly how many there are, or the circumstances leading to them.

Here’s my attempt to come up with some rough idea of how rare, or frequent, closed hearings might be.  In the course of observing 370 hearings, across approximately 300 different cases in the Court of Protection, and requesting without success access to around 700 more,  I’ve become personally aware of four closed hearing cases.  In two of these cases,  I observed a hearing at which the judge said explicitly that the case had also involved an earlier closed hearing: one was the open hearing in Re A,  the other was an open hearing that followed a closed hearing in Hull City Council v A & Ors[2021] EWCOP 60.  I sought access to, but was not admitted to the other two hearings.  One was the hearing before Hayden J that was subsequently appealed (In the Matter of P (Discharge of Party) AA [2021] EWCA Civ 512): in that case I was admitted to the video-platform only for the 5-10 mins it took for counsel to make their arguments (accepted by the judge) that the hearing should be held in private, and then I was asked to leave. The fourth closed hearing is one I only became aware of much later. I was refused permission to observe a hearing (randomly selected from the listings) before HHJ Haynes on 16 June 2020 in Leeds County Court: I subsequently identified it as the hearing that became the subject of an appeal about closed materials in KK v Leeds City Council [2020] EWCOP 64.[6]  So my own experience gives me a ballpark figure of maybe 4/1000 or 0.4%. This is likely to be an under-estimate[7].  In any case, 0.4% is rare, but not (in my view) “extraordinarily” so, especially given the large number of cases heard in the Court of Protection.

It would be helpful (and reassuring for family members of P) for the Guidance to ask that closed hearings, and closed material hearings, should be formally logged as such with some responsible administrative body within the Court of Protection so that their frequency can be known and reported annually  (e.g., in the form of “there were X hearings in the COP during 2023 concerning Y cases,  of which Z were closed proceedings or closed material hearings….. etcetera”, plus some summary detail about the features of the case that resulted in the closed hearings, and their outcome).

4. Closed hearings should be listed as such and open, in principle, to observers 

It seems that some closed hearings are not in fact listed.  In his judgment in Re A, Poole J reports his decision not to list the first closed hearing before him, and he acknowledges that: 

In retrospect it might have been possible to list the case without a case number or with a new case number created for the specific hearing, without any identifying names or initials to enable the listing to be linked to any previous open proceedings, and to make a reporting restrictions order at the hearing to prevent any communication or publication about the hearing (at least not until further order)” (§9 Re A). 

I support Poole J’s suggestion.  I recommend creating a new case number for a (first) closed hearing in a case which avoids linking the listing to previous open proceedings, and using the same closed case number for all closed hearings in the same case (thereby enabling identification of subsequent closed hearings in the same case).   I recommend clearly identifying the hearing as a ‘closed’ hearing in the listing (e.g. by stating “Closed Hearing” in the listing), thereby supporting the reporting and monitoring exercise advised above, and enabling journalists and the public to identify closed hearings as such.

Closed hearings should not normally be held in private.  There would be huge benefits in permitting observation of closed hearings by journalists and members of the public, subject to appropriate reporting restrictions and publication embargos.  One reason for having observers in court is to ensure that justice is seen to be done, to “keep the judge, while judging, under trial” and to “guard against improbity”.  This is arguably more important in closed hearings than in ordinary hearings attended by all parties. 

Obviously, the benefits of transparency would need to be considered on a case-by-case basis and balanced against the risks attached to having observers in court. I am simply suggesting that there should be no ‘in principle’ exclusion of observers from closed hearings.  And for those undertaking this balancing exercise, I draw attention to the fact that breaches of transparency orders, reporting restrictions and publication embargos have been very rare over the course of the last two and a half years, despite the huge increase in the numbers of observers in the Court of Protection, and that compliance with reporting restrictions has been maintained by both journalists and members of the public over long periods in other cases (e.g. more than 2 years in Hinduja [2022] EWCA Civ 1492)

5.  The Guidance should say that judgments from closed hearings should normally be published on publicly available sites (e.g. National Archives)

It is very important, in my view, that when judges discard the ordinary principles of judicial enquiry, that they publish judgments explaining why they have done so, and give a full account of the substantive issues in the case, the decisions they made, and reasoning behind those decisions.

This should be the norm for all closed hearings – but of course it is especially important when closed hearings are conducted in private.  As Poole J said in relation to the closed hearing in the Hull City Council case:

Without notice orders of the kind I have made in this application are exceptional and I consider necessary to set out the reasons for making them in a published judgment, suitably anonymised to protect A’s identity. By previous orders the proceedings have been conducted in private therefore they were not open to members of the public. Nor did any journalist or blogger attend. It is important that when the workings of the Court of Protection are carried out in such circumstances and powers are exercised of the kind I have exercised in this case, the court’s processes and reasoning are at least subsequently laid open in a published judgment.” (§2 Hull City Council v A & Ors[2021] EWCOP 60, Poole J)

The fact that some judgments from closed hearings are published means they can be evaluated to assess the extent to which it was necessary conduct closed proceeding (to protect P from harm and ensure P’s best interests).  Those I’ve read do support the need for closed proceedings: they’ve been concerned, for example, with physical, psychological or sexual abuse from the excluded party, or the risk of P’s removal to a foreign country in a forced marriage case. In addressing these concerns, judges act in accordance with Articles 16 and 19 of the Convention on the Rights of Persons with Disabilities – the duty upon States to protect those with disabilities from exploitation, violence and abuse, and to secure their right to independent living, respectively. 

These bases for “discarding” ordinary principles of judicial enquiry have been set out clearly in two judgments in particular:

(i) In Hull City Council v A & Ors [2021] EWCOP 60 (before Poole J), the protected party (A’s) son (her main carer) was excluded from a hearing at which an order was made to remove his mother from his home and transfer her to residential care. Her son has a long history of criminal activity including multiple convictions for supplying drugs and for assault.  He had obstructed all attempts by social workers and others to check on his mother’s safety, health and welfare by refusing access to the home. He was preventing  any meaningful contact with A inside or outside her home by the other parties to the case. The judge ruled:  “I am satisfied following the hearing on 2 November 2021 that if he were to have notice there would be a substantial risk that he would use the time afforded to him to obstruct A’s planned removal and conveyance. He would be likely to take steps to frustrate the purpose of the order. Those steps could put A at risk of harm. I am satisfied that the exceptional course of proceeding without notice to him is required in this case.”

(ii) In KK v Leeds City Council [2020] EWCOP 64 (an appeal heard by Cobb J against a decision by HHJ Hayes QC), the protected party (DK)’s maternal aunt (KK, formerly her main carer and the person she calls “Mum”) applied to be joined to proceedings and was refused party status by the judge at first instance, and then at appeal. As a teenager, DK had been a victim of child sexual exploitation and made allegations against KK’s husband and son of sexual abuse; these were investigated by the police over a period of 18 months (during which time KK and DK had no contact) before the police decided to take no further action. She has ongoing exposure to sexual exploitation and trafficking. The local authority alleged that KK’s relationship with DK exhibits elements of control and said that  “KK having party status would perpetuate and facilitate this control”.  Some of the evidence for this was in ‘closed materials’ which neither KK nor her legal team were allowed to see. Revealing these materials or joining KK to the proceedings would prevent her from “expressing her true wishes and feelings”, “undermine the process of ensuring her effective participation in these proceedings” and “interfere with DK’s right to respect for her private life”.

These judgments provide evidence of the need for closed hearings and address the basis on which decisions to conduct them were made. This is essential for public confidence in the law.  They also set out the decisions made and the reasoning behind them. 

There is no published judgment in Re A concerning the decisions made by HHJ Moir, at a closed and private hearing on 25 September 2020, to hold closed hearings and to initiate covert medication without the mother’s knowledge.  

I asked for the judgment from this hearing, or a transcript of it, to be published when I attended the hearing before Poole J as an observer on 21st-22nd September 2022. Although Poole J arranged for publication of another of HHJ Moir’s judgments in this case (from an earlier hearing at which she had declared hormone treatment to be in A’s best interests), his judgment made no reference to the crucial ‘closed’ hearing at which the decision was made that this medication should be given covertly and concealed from A’s mother. I emailed Poole J (via his clerk) on 12th November 2022 reiterating my request: 

“Given the draconian nature of this decision, made without the mother’s knowledge, and given the human rights implications that flow from it, it seems only right and proper that it should now be published so that the public (whose confidence in the COP’s judicial process may have been shaken by this episode) can understand the basis on which this decision was made…. If there are difficulties with publishing it as a formal judgment now that the judge involved has retired, can a transcript of the recording of the hearing be made public please?”.  

In his judgment at a subsequent hearing (on 14th November 2022) the judge authorised a transcript of this hearing and said that it should be made publicly available on the National Archives. This all took considerable persistence on my part and I’m not at all sure that concrete plans would ever have been made to publish this judgment without my involvement.  

My involvement in getting this transcript on the road to publication (it’s not there yet, and I will pursue it) shouldn’t have been necessary. The Guidance should say that all judgments from closed hearings (or in cases like this one, the transcript of the closed hearing) should normally be published – with redactions if necessary – unless there is some compelling reason why they cannot be.

Leaving aside, for a moment, concerns about the procedural issues associated with closed hearings, there is also the issue of the  substantive decisions made by the court: to deprive P of her liberty contrary to the wishes of both P and her mother; to use covert medication over (so far) a two-year period; to impose draconian restrictions on contact between mother and daughter.  Whether or not closed proceedings had been involved, this is the sort of case that raises fundamental issues of human rights, and I would want to see it published. 

In discussion with lawyers and others, there has been a tendency to conflate the question of whether or not it was right to conduct closed proceedings with the question of whether or not it was right to authorise covert medication etc.  These matters are clearly connected, but also distinct.

Since the transcript of HHJ Moir’s hearing of 25th September 2020 is not yet available, I am not currently in a position to consider what can be learnt about closed hearings from the way in which HHJ Moir conducted the proceedings. Without access to the facts at the time, and the reasoning of the judge, I cannot assess whether or not (in my view) the decisions she made were appropriate, proportionate and justified in the circumstances of the case. Or alternatively whether there might have been alternative (less coercive) means of pursuing the best interests of the protected party.  I have been somewhat surprised at how rapidly others (also without benefit of the 25th September 2020 transcript) have felt able to make a judgment one way or the other.  

I hope that the Guidance that eventually materialises as a result of the work of the subcommittee will consider lessons that can be learnt from the hearing of 25th September 2020, once the transcript is available.

6.  Guidance needs to deal with how to manage open hearings running in parallel with closed hearings – ideally by stating that this shouldn’t happen (certainly not over periods of months or years)

Poole J states the facts of what happened in Re A in his judgment (§86): “Open proceedings have been held in parallel with closed proceedings but information and material which was highly relevant in open proceedings was withheld from a party, B, and her legal representatives, who did not know that any information or material had been withheld”. 

These ‘open’ proceedings have been widely understood by members of the public to have been ‘fake’ hearings, whose only purpose was to disguise from the mother what was going on. This has led to concerns about deception in the Court of Protection.  My exposure to a ‘fake’ hearing (attended by Claire Martin as a public observer) has led me reluctantly to conclude that members of the Bar and the judiciary have a more flexible approach to truth-telling than I had previously believed.

From my reading of case law, it seems that running open hearings in parallel with closed hearings as was done in Re A is rare (perhaps unique to this case) – especially over such a long time-span (two years).  But I don’t know this for sure, since I don’t know whether other cases have simply not been published.

In my view, the Guidance should explicitly advise against running open and closed hearings in parallel. This is because when closed hearings concern matters of central significance to the open hearings, and their existence and/or subject matter are not revealed in the course of the open hearings, this is very likely to result in a perception of ‘bad faith’ from the court  – both from those excluded from the closed hearings, and from public observers.

One deeply regrettable outcome of Re A has been the opening up of a gulf between the legal view (or a legal view) and the public view of what happened in the open hearing (before HHJ Moir) in April 2022, attended by an observer from the Open Justice Court of Protection Project, Consultant Clinical Psychologist, Claire Martin.  

From the legal perspective (at least as articulated in court in the September 2022 hearing) nothing took place that should lead us in any way to doubt the court’s commitment to truthfulness.  In the course of Poole J’s hearing, my own dismay that public observers were (in my words) “misled” by the court was either denied outright (“nobody was misled”, counsel for the Trust) or reformulated to avoid any implication of deception: we were simply “under a misapprehension”, said the judge, claiming that the verb “to mislead” implies saying things that are untrue, as opposed to omitting to speak of things that are true. I found this disingenuous.  Most dictionaries include in their definitions of “mislead” omissions designed to create a false impression. 

There is – as my subsequent research has revealed – a debate in moral philosophy as to whether creating and maintaining a false impression (without explicitly speaking untruths) constitutes “lying” or not, and about the circumstances under which this behaviour might be justified, and the morality of equivocation. On the basis of that literature, I am confident in asserting that it is a defensible proposition to say that the court “misled” A’s mother, her legal team, and the public observer in the open hearing  – and that this was less than honest, less than truthful. This is also the view of many members of the public who’ve used terms like “charade”, “sham hearing”, “fake hearing”, “mock hearing”, “show trial” and “smoke and mirrors” in relation to the open hearings the mother was involved in, conducted under the shadow of the closed proceedings from which she was excluded.  The member of the public who attended the April 2022 hearing expresses it this way:

One key concern I have is the parallel mock hearings. I don’t see how this can ever be defended. It’s duplicitous as well as wasteful. It sets up a situation where you have to lie more and more to cover the original tracks.  If closed hearings are allowed, I think the system has to work out a way of handling additional applications from parties who have been excluded – in this case it seems they decided that they had to go ahead otherwise their cover was blown. This just does not seem befitting of a serious judicial system to me! I think my view would be that if an excluded party makes a subsequent application, then they have to be treated fairly and if the hidden information is material to the hearing for that application, they must then be informed about and included in closed hearings.” (Claire Martin, public observer at the April 2022 hearing in Re A)

Deception may sometimes be a necessary moral cost of acting in the best interests of the protected party (see below), but this doesn’t change its status as deception. 

It’s not simply my perception that the court has misled us, but also its denial that it has done so, that constitutes the moral chasm I now experience between my position and that of the court. It may be that there is an unbridgeable difference between us in relation to the ethics of truth-telling, but that difference could at least be acknowledged and some attempt made to deal with its consequences.

7.  The Guidance should address (and encourage lawyers and judges to address) moral complexity – in particular, the moral costs associated with making the right decision 

Many people in England and Wales share the court’s commitment to justice being done and being seen to be done: to fair and open hearings, with all parties on an equal footing and decisions based on evidence made known to all parties. This seems to accord with a widespread view of ‘natural justice’.  When courts depart from these fundamental principles of judicial enquiry, people can feel angry and dismayed at what they experience as potential injustice and abuse of power. This is a good thing.  It would be far more troubling if nobody cared when the court discards fundamental principles of judicial enquiry.

When courts discard the fundamental principles of judicial enquiry they do so because they believe that, in the individual facts of a case, those principles impede justice.  This is a weighty and challenging decision to make: there is a cost either to the procedures understood to constitute justice, or to a just outcome.  This places the court in a moral dilemma such that whatever course of action the judge decides upon has moral costs.  The fact that a decision may be the right one (or the ‘least bad’ under the circumstances) does not obviate the harm that may also be caused. It is in the nature of moral dilemmas that there are moral costs to making good decisions, and those who bear the burden of those costs can justly claim that they have been wronged. 

In the case of closed hearings (even when this is the right thing to do), there is harm done  to the excluded party.  Judges have recognised this, for example by highlighting the importance of considering – before granting a ‘without notice’ hearing – the impact it has on “… the rights, life, and emotions of the person against whom it is granted” (§41 B Borough Council v S & Anor | [2006] EWHC 2584 (Fam).  I can only imagine the sense of moral outrage, violation, and fury that being excluded from a closed hearing about a loved one would engender in me.

When a party’s legal team is excluded from closed hearings and not informed about their existence (as in Re A), they too can feel wronged. They may feel victims of some version of ‘justice’ quite unlike the ideal they signed up to when they chose to become lawyers. It can be corrosive of their professional identity and sense of their own professional efficacy. One lawyer who’d been refused permission to view ‘closed materials’ told me how frustrated he felt about this, saying he still couldn’t understand (some years later) why this refusal had been necessary. A couple of other lawyers with whom I discussed the Re A case  told me that they would not expect ever to be placed in the position of counsel for A’s mother because their reputation means ‘nobody would dare’ to (as one put it) ‘pull the wool over my eyes – and anyway I’m sure I’d see through it’.  What does this perspective mean for those lawyers who have been excluded from hearings or from closed materials, and (if this has been kept secret from them) who have not divined what has been going on? The implication seems to be (and these lawyers may feel) that they have failed in their duty to their clients, that they lack professional acumen or expertise, that they forfeit the respect of colleagues – not just those who excluded them from a closed hearing, but those in the wider community of the Bar. In Re A I saw in the reaction of counsel for A’s mother (in court in September 2022) some indication of the moral injury he felt had been done to him as a professional[8].

I think there is also a moral cost to the lawyers included in closed hearings and to the judges who hear them  – especially when (as in Re A) there is secrecy about those proceedings. They may well believe that they are doing the right thing, and that their course of action is the only way P’s best interests can be secured, but it’s possible at the same time to feel regret that secrecy and deception are the price to be paid for doing the right thing in these circumstances.  Avoidance of truth-telling can harm the person doing it even when they are acting for benevolent reasons (e.g. studies of moral stress experienced by caregivers who validate a dementia patient’s reality at the cost of truth, e.g. that her spouse is dead and won’t be coming home for tea[9]).  Empirical research finds a range of  morally self-reassuring strategies people use to disregard or minimise the moral costs of engaging in the right action – including, in the case of dementia carers, adopting a consequentialist position (‘the end justifies the means’) – a moral-cost-evasive approach that can function to avoid moral ambiguity – and characterising their actions relatively benignly as “white lies” or “colouring the truth”,  “manoeuvring around the truth”,  “not out-and-out lying Practitioners have produced guidance for lying to dementia patients[10].  Lawyers and judges are heavily invested, of course, in a professional identity involving honesty and rigorous regard for the truth: I suspect that explicit acknowledgement that they are less than honest on occasion is challenging.

Some theorists have drawn on philosopher Bernard Williams’ analysis[11] of what he calls the ‘moral remainder’ in considering judicial approaches to complex moral decisions.  It’s based on the observation that even right decisions can cause harm (albeit less harm than the wrong decision).  To take the famous ‘trolley problem’[12] example, if I divert a runaway tram or trolley that is on course to collide with and kill five people down the track, so that instead it kills just one person on a different track, this may well be the right decision (I’ve saved four lives), but one person who would otherwise have been alive is now dead because of my decision.  Bernard Williams uses the phrase ‘agent regret’ to describe the emotion that gives expression to the fact that one has committed a wrong despite the fact that one’s actions were overall not mistaken.  “Shame, regret, guilt,  remorse for those wrongs can be felt by people who did the right thing – and can be appropriate responses to the moral harm caused in pursuit of the right thing[13].

The Guidance should support moral literacy by addressing the fact that in complex moral dilemmas it may be necessary to recognise that acting for the best does not always yield a morally clean result.  It’s appropriate, then, to discuss how to manage the moral harms that result from good decisions.

8.  The Guidance should state that observers must not be admitted to ‘fake’ hearings (if they continue to happen) without proper briefing.

My strong view is that hearings like the April 2022 hearing (widely described as a ‘fake’ or  ‘mock’ hearing) should not be part of Court of Protection practice.  As one case manager (also a COP observer) said, this kind of “masquerade” is “degrading to those involved”.  If, in future, these kinds of hearings are avoided, then there is no risk of public observers finding ourselves in the invidious position we experienced in Re A.

If they are to be accepted as part of Court of Protection practice, then admission for public observers should be contingent on full disclosure of the facts from the court, along with the issuing of a Reporting Restrictions Order and/or publication embargo.

I struggle to find any justification for admitting an observer, without any briefing, to the April 2022 hearing before HHJ Moir. It must have been obvious to counsel and to the judge (if they had given it a moment’s consideration) that the observer would not be able to write an accurate account of the case. It made a mockery of transparency to admit her.

This is how the observer concerned expresses her view: 

Allowing a public hearing to proceed under these circumstances and admitting me as a public observer makes chumps of me, the mother and her legal team (and the public reading the reports) really – and apart from the serious consequence of loss of trust in the system, I’d also say that the cost and utter waste of time for everyone involved is indefensible.” (Claire Martin, observer April 2022 hearing)

The suggestion has been made that excluding an observer might have alerted counsel for the mother that something was awry:  “… if I was acting for a party and the judge specifically determined that a hearing take place in private, and then excluded observers… then I’d probably wonder why – which might have led me or my client to wonder if there were things happening we were not told of… not easy” (COP lawyer).  If the observer was in fact admitted for that reason, she was being used (as Daniel Cloake suggests in his blog post covering the first day of the hearing before Poole J), as “some kind of prop to add an air of legitimacy to an otherwise compromised application”.

The reverberations of admitting an observer to this hearing (without properly briefing her and serving a Reporting Restrictions Order) are far-reaching and deeply unhelpful to us as observers, to journalists, to members of the public more broadly, and to the Court of Protection itself.

It’s caused harm to those of us actively running the Open Justice Court of Protection Project, leading us to doubt the value of our work.  Not only did we publish a misleading account of a case but also it was an account which promoted the version of events the court wanted the mother to believe – thereby making us complicit in the court’s deception without our knowledge or consent. 

Moreover, our blog post could also have (inadvertently) jeopardised the whole endeavour in which the court was engaged in pursuit of A’s best interests, because it raises the matter of covert medication.  In our blog post Claire Martin wrote: “I don’t know whether or not the options of covert medication (or restraint to ensure treatment) have been considered. (They may have been considered in one or more hearings that we missed).” There is no evidence that the mother in this case read our blog – but had she done so, this could surely have alerted her to a possible scenario in her own case.  The court should never have created a situation in which this could arise.

This whole episode has led to scepticism, from journalists and from the public, about the court’s professed commitment to transparency:

When details are hidden rather than being subject to reporting restrictions, it shakes the confidence of observers and reporters in the whole system” (Tristan Kirk, journalist)

How can I trust that any hearing I attend isn’t tainted by having secret, covert hearings going on ‘underneath’ the ones I observe?’ (Louise Tickle, journalist)

From the perspective of transparency, admitting us to a hearing at which salient facts are concealed from one of the parties and from us, such that we will inevitably form a false impression of the case, is far worse than not admitting us to the hearing at all.  It’s a form of ‘double-crossing’.  The presence of the observer in court – the very thing that is supposed to guarantee transparency – becomes instead a source of misinformation and false news. It runs directly counter to the purpose of having observers in court in the first place.

Family members involved in Court of Protection proceedings often tell us that they believe that having an observer present will ensure that the judge “behaves himself” and “doesn’t do anything wrong – because you’ll be watching!”  We know they have found some comfort from having someone independent and impartial as a witness to their story.  They’ve reported that the judge was “fairer” to them because observers were there and commented that, without observers,  judicial unfairness is “unlikely to be found out[14].  And in writing about our Project, we have often quoted Bentham” “Publicity is the very soul of justice. It is the keenest spur to exertion, and the surest of all guards against improbity. It keeps the judge himself, while trying, under trial”.

In future, we will have to tell P and their family, when they approach us asking for someone to observe their hearings, about our experience in this case.

When members of the public come to believe that people in positions of power are not dealing honestly with us, we become disaffected not only with those individuals (judges and lawyers) but also alienated from the institution they represent.  The way this hearing was managed was an own-goal for the Court of Protection.

The Court of Protection needs to take steps to ensure that nothing like this ever happens again.  

9. The Guidance should emphasise the need to inform the excluded party about closed proceedings as soon as possible (not least, to enable an appeal)

The Guidance needs explicitly to address the importance of determining, before or during the course of a closed hearing, when and how someone (who?) is going to inform the excluded party that the closed hearing has taken place and its outcome.  

In Re A, the excluded party and her legal team had not been informed two years later, and it took the intervention of a new (Tier 3) judge to ensure that she was so informed – apparently (as I understand it) without this having been a position put forward by any of the other parties.

Re A is an unusual case on its facts.  In much of the case law, the excluded party seems to have been informed very quickly (within hours or days of the hearing) – not least because the most common reason for closed proceedings seems to be the removal of P from the excluded party’s home, meaning that they discover the existence of the court order quite promptly in any case.

Earlier guidance (from 39 Essex Chambers) specifies that: “Those who obtain ex parte relief are under an obligation to bring to the attention of the respondent at the earliest practicable opportunity the materials on the basis of which the ex parte injunction was granted… The obligation involves giving proper information about what happened at the hearing. Representatives should respond forthwith to any reasonable request for information about what took place.”

It’s not clear to me what “the earliest practicable opportunity” might have been for informing the excluded party in Re A.  It would be helpful for that to be considered and addressed in order that any future cases with similar features can benefit from lessons learnt.

One consequence of not informing an excluded party about decisions made in closed proceedings is that they are not able to appeal the judgment in a timely manner.  This seems fundamentally unjust.  It distinguishes this case from other cases (e.g. In the Matter of P (Discharge of Party) AA [2021] EWCA Civ 512) which is an appeal consequent upon a first instance judge having informed a party of her exclusion from a hearing, thereby enabling an appeal against it).

10.  Additional issues to consider

10.1  A Tier 3 judge? Would it have helped if Re A had been referred to a Tier 3 judge sooner? Should the guidelines indicate the level of complexity at which such referral is required? (In this case the fact that it concerns what used to be labelled ‘serious medical treatment’ seems on its own, to merit a Tier 3 judge.)

10.2. Would it help to have some kind of ‘Special Advocate’ (s.9 Justice and Security Act 2013) to represent the interests of the excluded party?  I recognise that existing guidance from 39 Essex Chambers suggests that the judge should be provided with “a brief account of what the applicant thinks the respondent’s case is, or is likely to be” (X Council v B (EPO) [2004] EWHC 2015 (Fam), [2005] 1 FLR 341, [53], Charles J).  Based on my experience of Re A,  however, I have little confidence that this would work, or that the excluded party would feel that her interests were protected by this.  This opinion is based on the way in which the excluded party was addressed in court in an earlier hearing  (“You are making up all of this in order to support a return home…. This is a ploy by you… You’re making this up aren’t you… You are fabricating a story…This shows a level of deviousness that you cannot be trusted in terms of contact…” Hearing of 26 May 2020, Re A). 

10.3 What should people do if they think they may have been excluded from closed hearings but nobody has so informed them? I did not receive any communications from family members of Ps who were able to report having been excluded from proceedings or denied access to closed materials. Some speculated that there might have been hearings of which they were unaware and pointed out that I was asking an impossible question when seeking information about hearings from which they’d been excluded and the existence of which had been kept secret from them. They asked what they should do to find out if secret hearings had occurred.  (I suggested asking the judge a direct question:  “were there hearings I was excluded from?” – I don’t know if that was a good suggestion or not?)

10.4  Excluding P: The terms of reference for this subcommittee specifically exclude consideration of “hearings which take place without the knowledge of P, but with the knowledge of P’s litigation friend”.  Although I circulated the terms of reference with my call for feedback, the single most frequent response from family members concerned exactly this scenario. Family members were concerned when P wasn’t told about hearings: “She is totally unaware of hearings and what is being said about her” (Mother of P).  “She’s supposedly the applicant in this case, but nobody has even told her the hearings are taking place” (Daughter of P).  It was reported that P’s legal representation was inadequate or misleading.  “The lawyer supposedly representing her hasn’t even met her, and has no idea what her views are” (Daughter of P); “Her Barrister has no thoughts other than backing the Local Authority, even regarding serious impositions such as deprivation of liberty” (Mother of P).  “She is saying repeatedly that she doesn’t want this, but her own lawyer argued in court that she should have it. Surely this can’t be right? She must be entitled to a lawyer who will argue her corner?” (Sister of P).  One family member told me that P was unhappy with her representation and had asked for a change of solicitor, which had been refused.  In addition to these family reports, I have  personally observed several hearings (usually ‘urgent’ ones convened at short notice) at which the Official Solicitor stated explicitly in court that they had not been able to contact P before the hearing and had no direct information as to P’s wishes or feelings.  The role of the litigation friend in this situation seemed largely symbolic. Nonetheless, major decisions (including serious medical treatment) were made at some of these hearings. I raise these concerns here since it seems probable that members of the public may expect this matter to be covered in the Guidance (albeit that I recognise that it raises very different concerns).

Celia Kitzinger


[1] Some of the case law comes from cases concerning children, but Sir James Munby P in RC v CC [2013] EWHC (COP) 1424 (‘C v C‘) confirmed that the well-established (albeit exceptional) jurisdiction to refuse disclosure of materials to the parties in children cases is of equal application in the Court of Protection (at §20). Additionally, some of the Family cases concern adults without capacity predating implementation of the Mental Capacity Act  2005 (e.g. B Borough Council v S & Anor | [2006] EWHC 2584 (Fam).  In the Family Division: In re S (A Child) (Family Division: Without Notice Orders) [2001] 1 WLR 211, Munby J; W v H (Family Division: Without Notice Orders) [2001] 1 All ER 300, Munby J.  In the Court of Protection: Hull City Council v A & Ors [2021] EWCOP 60, KK v Leeds City Council [2020] EWCOP 64.  In the Court of Appeal (concerning a COP case): In the Matter of P (Discharge of Party) AA [2021] EWCA Civ 512

[2] That hearing was ‘ineffective’ (i.e. did not actually go ahead as planned, although it took up more than two hours of court time), ostensibly because the Local Authority had failed to visit the mother’s house to assess the viability of a return home.  (See Claire Martin’s account of this hearing: Medical treatment, undue influence and delayed puberty: A baffling case.)

[3] Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009 Dec;29(8):695-706. doi: 10.1016/j.cpr.2009.07.003. Epub 2009 Jul 29. PMID: 19683376.

[4] This concerned a ‘without notice’ application to deprive a vulnerable adult of his liberty under the inherent jurisdiction rather than the Court of Protection. The judge (Mostyn J) did not make any enquiries as to whether the appellant or his solicitor could be contacted in order to make representation. The appeal was allowed and Lord Justice Baker (with whom the other two judges agreed) ruled that “In my judgment, the Trust’s application for, and the granting of, the order for which there was no proper evidence and without giving Mr Mazhar the opportunity to be heard amounts to a clear breach of his article 6 rights and was a flagrant denial of justice.” Mazhar v. Birmingham Community Healthcare NHS Foundation Trust & Ors. [2020] EWCA Civ 1377.

[5] Hayden J, quoted in Joshua Rozenberg’s blog post, “Open Justice at the Court of Protection”, 25th October 2022.

[6] My request to observe that hearing was not motivated by my knowledge of the issues before the court – I’d simply selected a random hearing at a convenient time, and received a reply telling me “The Judge has now been is touch and has stated that you will not be able to join the hearing due to highly sensitive nature of the material being considered.” (email from listings clerk at Leeds County Court).  

[7] I don’t have much confidence in this statistic since (a) there may be other hearings I attended at which judges did not reveal the existence of previous closed hearings; (b) some of the hearings to which I was refused access may have been closed hearings, the existence of which has not subsequently come to light through published judgments; (c) Many of the hearings to which I was not admitted were vacated, so shouldn’t really be included in the total (d) It seems that some closed hearings aren’t ever listed, so I could never stumble over them in making random observation requests. All these factors work in the same direction – to increase the number and percentage of closed hearings in the Court of Protection to something rather higher than my 0.4% estimate.

[8] I found it quite painful to watch this lawyer step out of his advocacy role for A’s mother (she was not at that point raising concerns about the closed hearings) to speak on his own behalf about his experience of the proceedings as Kafka-esque, and about not having been able to advocate effectively for his client. I hope his concerns were managed better outside court than they were during the course of the hearing (where he was simply dismissed as ‘grandstanding’ and corrected for using the word ‘mislead’ – it all felt quite brutal).

[9] Tuckett, A.G., 2012. The experience of lying in dementia care: A qualitative study. Nursing Ethics19(1), pp.7-20.  Elvish R, James I, Milne D. Lying in dementia care: an example of a culture that deceives in people’s best interests. Aging Ment Health. 2010 Apr;14(3):255-62. doi: 10.1080/13607861003587610. PMID: 7140,E., 2009. Withholding truth from patients. Nursing Standard23(48). McCabe, M.S., Wood, W.A. and Goldberg, R.M., 2010. When the family requests withholding the diagnosis: who owns the truth?. Journal of Oncology Practice6(2), p.94. Sarafis, P., Tsounis, A., Malliarou, M. and Lahana, E., 2014. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Global journal of health science6(2), p.128.

[10] https://ugc.futurelearn.com/uploads/files/57/ec/57ecfe86-1a98-4540-b009-bb73660e0883/Guidelines_on_therapeutic_lying.pdf

[11] Bernard Williams, ‘Conflicts of Values’, Moral Luck: Philosophical Papers 1973–1980 (Cambridge University Press 1981.

[12] https://en.wikipedia.org/wiki/Trolley_problem

[13] For applications of the concept of ‘moral remainders’ to legal practice see: Iris van Domselaar (2022) Law’s regret: on moral remainders, (in)commensurability and a virtue-ethical approach to legal decision-making, Jurisprudence, 13:2, 220-239, DOI: 10.1080/20403313.2021.2014709. and van Domselaar, Iris, The Fragility of Legal Ethics: On the Role of Theory, Lawyerly Virtues, and Moral Remainders in the Life of a Good Lawyer (October 27, 2022). Available at SSRN: https://ssrn.com/abstract=4260601 or http://dx.doi.org/10.2139/ssrn.4260601. The concept is also used in theorizing about public policy e.g. Arguelles A & McCaskill J (2018) Minimizing the moral remainder, Journal of Public Administration and Governance 8(3): ISSN 2161-7104.

[14] See How being watched changes how justice is done: ‘Insider’ Perspectives