What families mean by “gravitas” (dignity, seriousness, solemnity) does not in fact reside in court architecture, coats of arms, wigs and robes, or rituals of address and behaviour. In my experience, these external manifestations of “justice” can sometimes seem rather ridiculous, and the “performance” element of the courtroom can alienate lay people and distract everyone from the serious business at hand. Rather, the “gravitas” families appreciate is a quality of attention, a focus, a willingness to engage, in depth, with the medico-legal and ethical issues before the court.
especially psychiatric/psychological diagnosis. He ensures that the relational interplay between the health and social care organisations and each P is noted. This means that ‘behaviour’ is not located in P (or conversely only in the clinicians/teams/organisations) but in the relationship between them. Given the location of power in a patient-to-system dyad, I think this is vital in CoP cases. It conveys to each person at the centre of a case that they matter as a person in the CoP.
reflect on how having some level of oversight from a professional who is somewhat independent, and who can initiate communication with separate bodies (i.e. care home management, local authority, health commissioning) can be pivotal in ‘making things happen’ for P, that wouldn’t have necessarily happened without such intervention.
The Health Board was seeking a declaration from the court either  that PH does have capacity to refuse nutrition and that his wishes not to continue to be fed should continue to be respected, even if this means his death; OR  that PH lacks capacity to refuse nutrition and that it is not in his best interests to attempt to feed him nutrition against his wishes and so he should be allowed to die.
The Judge then went on to say that as I had only requested access at 10.50pm the evening before, she had not had time to go through formalities. She then referred to Claire Martin, another public observer (and core member of the Open Justice Court of Protection Project) who was also observing the proceedings and requested that we ‘kindly leave’. So that was that. Abrupt as it was, I duly obliged, and felt slightly down beaten at this point.
Counsel asked whether, if the court were of the view that CPR was in AB’s best interests, the treating team would then be willing to administer CPR. This question was presumably designed to address a lack of clarity (quite common, in my experience, in Court of Protection cases) as to whether a proposed treatment is actually an available option for the court to consider. The court cannot order doctors to give futile treatments – and CPR had been so described by Dr G.
All this detailed planning – what needs to be provided by what deadline and by whom – is part of preparing for a full hearing, especially where (as here) matters are contested. Hearings like these feel relatively pedestrian: they lack the intrinsic interest we all feel about the ethically weighty decisions made in final hearings. But they are the essential scaffolding upon which those final hearings depend.
The RHN clearly failed to provide high-quality, patient centred care – and part of this Court of Protection judgment is dedicated to exploring why this happened and what lessons might be learned.
Mr Justice Hayden is well-known (and celebrated) for his robust defence of autonomy and self-determination. And yet in this instance I got the impression that, faced with a decision about a pregnant woman, his protective instincts had (temporarily) overwhelmed him. I am relieved that he adjourned the hearing rather than precipitously (in my view) declaring SM to lack capacity and making a premature decision about her best interests.
Gaby Parker and Celia Kitzinger, 30th October 2021 A man in his 40s (PH) has bronchiectasis. Last night his oxygen levels became seriously low (79%) and doctors raised with him the possibility of transfer to the intensive care unit, or to high dependency care. He refused to go. He’s made it unambiguously clear that he’ll consent toContinue reading “Capacity to refuse intensive care”