St. George’s Healthcare NHS Trust v. S

S, who was 36 weeks pregnant, was diagnosed with severe pre-eclampsia, a life-threatening condition of pregnancy characterized by high blood pressure, and with moderate depression. She was advised that her health and her life, and that of her baby, were in real danger and that she needed to be admitted immediately to hospital for an induced delivery. S fully understood the potential risks but rejected the advice on the grounds that she wanted her baby to be born naturally.

On the application of C, a social worker approved under Canada’s Mental Health Act (“Act”), S was admitted to a mental hospital against her will for assessment under section 2 of the Act as it was feared that her mental state was compromising her ability to make decisions. S was immediately transferred again against her will to St. George’s Hospital, which then applied ex parte for a declaration dispensing with her consent to treatment. Inadvertently misled into thinking that S had been in labor for 24 hours, a High Court judge granted the declaration, and S’s baby was born by Cesarean section. S returned to the mental hospital, discharging herself two days later.

S appealed against the High Court judge’s order and sought judicial review of C’s decision to admit and detain her under the Act.

[Adapted from INTERIGHTS summary, with permission]

The Court held that S had the right to refuse medical treatment even if it would endanger the life of her or her fetus. The Court reasoned that an adult of sound mind is entitled to refuse medical treatment because each individual has the right to autonomy and self-determination. The Court state that while pregnancy increases the personal responsibilities of a woman, it does not diminish her entitlement to decide whether or not to undergo medical treatment. Nor is her right reduced or diminished merely because her decision to exercise it may appear morally repugnant. An unborn child, although human and protected by the law in a number of different ways, is not a separate person from its mother. Its need for medical assistance does not prevail over the mother's rights and she is entitled not to be forced to submit to an invasion of her body against her will.

The Court further held that the removal of S’s baby from within her body under physical compulsion constituted an infringement of her autonomy which was not justified by the perceived needs of the fetus. The Cesarean section performed on her, and accompanying medical procedures, also amounted to trespass. The Court stated that Act could not be deployed to achieve the detention of individuals against their will merely because their thinking process is unusual, bizarre or irrational and contrary to the views of the overwhelming majority of the community at large. The evidence showed that those involved in the decision to make an application for S’s admission failed to maintain the distinction between the urgent need for treatment arising from her pregnancy and the separate question whether her depression warranted her detention in hospital. There was nothing to suggest that an application for S’s detention would have been considered, let alone justified, if she had not been suffering from severe pre-eclampsia. In the circumstances, S’s detention, treatment and transfer were unlawful.

[Adapted from INTERIGHTS summary, with permission]

". . . how can a forced invasion of a competent adult’s body against her will even for the most laudable of motives (the preservation of life) be ordered without irremediably damaging the principle of self-determination? When human life is at stake the pressure to provide an affirmative answer authorising unwanted medical intervention is very powerful. Nevertheless, the autonomy of each individual requires continuing protection even, perhaps particularly, when the motive for interfering with it is readily understandable, and indeed to many would appear commendable; hence the importance of remembering Lord Reid’s warning against making ‘even minor concessions’. If it has not already done so, medical science will no doubt one day advance to the stage when a very minor procedure undergone by an adult would save the life of his or her child, or perhaps the life of a child of a complete stranger. The refusal would rightly be described as unreasonable, the benefit to another human life would be beyond value, and the motives of the doctors admirable. If however the adult were compelled to agree, or rendered helpless to resist, the principle of autonomy would be extinguished." Page 688.

"In our judgment while pregnancy increases the personal responsibilities of a woman it does not diminish her entitlement to decide whether or not to undergo medical treatment. Although human, and protected by the law in a number of different ways set out in the judgment in Re MB, an unborn child is not a separate person from its mother. Its need for medical assistance does not prevail over her rights. She is entitled not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depends on it. Her right is not reduced or diminished merely because her decision to exercise it may appear morally repugnant. The declaration in this case involved the removal of the baby from within the body of her mother under physical compulsion. Unless lawfully justified, this constituted an infringement of the mother’s autonomy. Of themselves, the perceived needs of the foetus did not provide the necessary justification." Page 692.