Court of Protection (Mental Capacity Act) cases
The Court of Protection is a part of the Family Division of the High Court that deals exclusively with Mental Capacity Act cases. The rulings of the Court give guidance to professionals and organisations in how to interpret the Act.
We list here some of the most significant rulings of the Court. The list is regularly updated as new cases come in, the most recent cases being nearest the top of the list. If you have any suggestions of cases you would like us to include please let us know.
Many of the links here come from the excellent resources on the website of 39 Essex Barristers' Chambers.
We naturally update our training to take account of Court rulings.
Click here to read David Thornicroft's account of observing a Court of Protection hearing in June 2020.
Yet another case relating to consent to sex. The issue here was that the man, JB, understood that he would have a choice, and could refuse to consent to sex, but he did not appear to understand that his sexual partner could also refuse. The Court of Protection had originally ruled that JB had the capacity to consent to sex. That ruling was appealed, hence the Court of Appeal judgement. The case then went to the Supreme Court, which agreed with the Court of Appeal. The always excellent Alex Ruck Keene has written an extensive analysis of this case here.
A 76 year old woman with dementia was living at home with her son. She lacked capacity to conduct this litigation, or to make decisons about her residence and care. The local authority had serious concerns about the way in which her son was caring for her, and the way in which he obstructed their efforts to check her welfare properly. Therefore the local authority asked the court to order that she be removed from the house into a care home.
The Court of Protection had originally ruled in April 2021 that care workers would NOT be breaking the law if they were to help a 27 year old man with Autism to access the services of sex workers. The BBC picked this story up as well here. The case went higher, to the Court of Appeal, which overturned the original decision. The Court of Appeal said that care workers WOULD be breaking the law if they were to do this. Again this story was picked up in the mainstream media.
An 80-year-old Jehovah's Witness had stated in 2001 that she would never consent to having a blood transfusion. Now needing one, and dangerously close to death, the case came to Court at short notice for a ruling on whether the statement from 2001 was still valid today, or whether PW had done things since then which would indicate a change of mind.
Not the Court of Protection, but instead a ruling by the Local Government Ombudsman. The LGO upheld a complaint brought by a man about the way his late partner was placed in a care home. The man complained that the Council had not followed its own Mental Capacity Act policies correctly, and had not followed the DoLS procedure correctly either.
BU was a 70 year old woman with vascular dementia and significant financial resources. There were concerns about her relationship with NC, a man aged 50. BU's family was very concerned that NC exerted coercive control over BU. NC had a string of previous serious convictions, including dishonesty.
- Cambridge University Hospitals NHS Foundation Trust v AH & Ors (Serious Medical Treatment)  EWCOP 51
AH was a 56 year old woman who was described by the Judge as being "the most complex COVID patient in the world". She had been in critical care for 9 months and the question was whether ventilatory support should continue.
A 24 year old man with autistic traits, frequent drug/alcohol user, had almost an obsession with seeking out sex, and this was placing him in dangerous situations
Whether to give the COVID vaccine and the booster to a 30 year old man who lacked the capacity to consent to it.
Miss K was a woman in her late 30s, pregnant, and currently detained under the Mental Health Act due to schizophrenia. The question was about giving birth by Caesarean section.
A pregnant 21 year old woman was reluctant to go to hospital for the birth due to agoraphobia, and the Court authorised her to be taken there by force if necessary. There was, understandably, a big reaction to this case when it was reported in the media. There are a couple of excellent blog posts discussing the issues here, here and here. Shortly after the hearing the mother travelled to the hospital with family support and under sedation where she gave birth to a healthy baby boy.
Whether a 49 year old woman should receive treatment for her anorexia against her wishes.
Whether an 86 year old woman with dementia, living in a care home, should have the COVID vaccination, against her wishes. This would have involved restraint and sedation (or possibly telling her that her father, whom she believed to be still alive, had agreed for her to have it). The Court ruled that it was not in her best interests to have the vaccination.
An 87 year old lady (GA) was living with her son (TA) whose behaviour towards her could be classed as abusive. GA lacked the capacity to decide whether to allow her son to continue to live with her, therefore the local authority wanted the court to order TA to leave and to cease contact with his mother.
Whether a 31-year-old man with learning disabilities, epilepsy and autism should have the COVID-19 vaccination, against his father's wishes. His father blamed CR's autism on an MMR vaccination which CR had received in 2001.
GH was a pregnant 26 year old woman with agoraphobia and anxiety, and the case was around whether a home or hospital birth was best for her.
A 29-year old woman with a mild learning disability wanted to continue her sexual relationship. COVID restrictions further complicated this issue.
Whether a woman in her 70s, with Korsakoff's Syndrome, should have the COVID-19 vaccination, against her daughter's wishes. The daughter felt the vaccine had not been properly tested, which effectively meant that her mother would be taking part in a trial of it.
A 37 year old man with rare epilepsy syndrome and significant communication issues - where should he live?
A 68-year old woman with persistent delusional disorder and co-morbid depression wished to return to live in Poland. Amongst other things the Judge cautioned that the "balance sheet" approach is not necessarily the best way of working out what to do.
E is an 80 year old female resident of a care home, who had been offered the COVID vaccine. There were doubts about her mental capacity to consent to having it, and also her son (who did not have Power of Attorney) was reluctant for her to have it due to the speed with which it had been approved for use.
A 30 year old man with autism and learning disabilities ... a dispute arose with his stepfather which led to contact with family being denied, all within the COVID lockdown rules.
Whether "Gillick Competency" does only apply to young people up to the age of 16. (A High Court Case, not the Court of Protection).
A 19 year old man with autism and Asperger's wished to engage in a sexual practice known as "auto-erotic asphyxiation" to heighten his sexual enjoyment. He had advertised on the "Dark Web" his desire to be kidnapped and raped. There were concerns about his capacity to make these decisions.
A 24 year old man with learning disabilities, schizophrenia and ADHD whose teeth were in an "appalling state" and who refused dental treatment.
A case heard during the COVID lockdown of 2020 - the hospital wished to discharge MB from her hospital room, where she had been for over a year, because there were other more deserving patients who would need that room. MB argued that this would cause her great mental distress leading to self harm or suicide.
Whether a 52-year-old man with a history of serious alcohol misuse had capacity to make decisions about his care and residence.
A 57 year old woman, blind, wheelchair user, with learning disabilities who had very painful teeth, so the proposal was for full dental clearance under general anaesthetic.
35 year old man with LD and ASD, lots of issues including use of social media to contact men for sex and relationships. Good explanation of the concept of executive capacity.
A case heard during the COVID lockdown of 2020 - the family of a terminally ill woman wanted her to be allowed to leave the care home where she had lived since 2010 to come home to die amongst her family.
Whether a 69 year old woman with dementia could have capacity to make residence decisions, whilst lacking capacity to make care decisions.
A case heard during the COVID lockdown of 2020 - a Spanish national with dementia and Parkinson's had been brought over to England where he was now residing in a care home, but the Court of Protection ruled that his move from Spain to England was unlawful (because he'd essentially been "abducted" by his adult children without the knowledge of his wife) and that he should be returned to Spain ... however during the lockdown that would of course be impossible. The case had been heard previously here.
The Trust applied for a declaration that it was in AB's best interests to have an intrauterine contraceptive device (IUD) fitted when she had a caesarean section. This case had previously been heard as An NHS Trust v AB, CD and a Local Authority  EWCOP 26, which considered whether it was in AB's best interests to have a termination. The Court of Protection ruled that it was, but that decision was switftly overturned by the Court of Appeal in Re AB (Termination of Pregnancy)  EWCA Civ 1215.
AB is a 51-year-old man with a diagnosis of moderate learning disabilities, autistic spectrum disorder, harmful use of alcohol and psychosis due to solvent abuse. He lived in supported housing and met prostitutes for sexual relations, at times travelling to the Netherlands to meet sex workers there. This was an application by the LA for the court to determine P's capacity and best interests, specifically with regard to contact with sex workers.
A case which generated a lot of media interest, and no little outrage, when the Judge was initially reported as having commented: "I cannot think of any more obviously fundamental human right than the right of a man to have sex with his wife". The case itself is a lot more complicated than that simple soundbite would lead you to believe.
A 24 year old woman with learning disabilities and challenging behaviour was 22 weeks pregnant and lacked the mental capacity to decide whether to have the baby or have a termination. The Judge was very unhappy that the case had taken so long to come before the Court.
An unusual case concerning a pregnant 27 year old woman with diagnoses of paranoid schizophrenia and emotionally unstable personality disorder. Although she currently had capacity to make decisions about the birth, past history would suggest that at the time of actually giving birth she may well lack the capacity to make decisions about medical help. So her medical team was asking the Court to give them guidance now as to what they could reasonably do if that event were to happen.
A very wealthy 75 year old man had appointed a much younger woman to be his LPA. His son challenged his father's mental capacity to make that decision. His father dismissed his solicitor and wished to conduct his own defence in court, but the Judge ruled tbat he lacked the mental capacity to litigate.
RW was a 78 year old man with advanced vascular dementia and who was clearly very close to the end of his life. The issue was what treatment to give and/or to withhold. The judgement is notable for the way in which the Judge seeks to bring RW's character to life, mainly through the evidence of his sons who have been struggling to care for him.
- Kings College Hospital NHS Foundation Trust and FG, and South London & Maudsley NHS Foundation Trust  EWCOP 7
FG, a man who had paranoid schizophrenia, had dislocated and fractured his shoulder, requiring surgery. FG was very fearful of anaesthetic, and the prospect of surgery, leading him to refuse to have the surgery.
PBM, a man in his mid-twenties, had a brain injury as a result of a deliberate injection of insulin by his father when he was 12 months old. Various issues were considered in this case, including PBM's capacity to marry and to enter into a pre-nuptial agreement.
B is a woman in her 30s who has a learning disability. The Court had to consider various capacity issues, including regarding her care and treatment, consenting to sexual relations and using the internet and social media. In the past B had used social media to send intimate photographs of herself, and to give out her home address to strangers. This case then went further to the Court of Appeal here  EWCA Civ 913. The Court of Appeal upheld the Court of Protection's rulings that B lacked the capacity to use social media, and that she lacked the capacity to consent to sex. However it overruled the Court of Protection's ruling that B had the capacity to make residence decisions.
A, a 21 year old man with a learning disability, was known to search compulsively for pornography on the internet when unsupervised. Much of the content was paedophiliac and extreme, even illegal, sexual activity. There was a concern that he did not understand the warnings regarding content and safety.
This case revolved around KR, a lady in her 80s who had dementia, and who had been the subject of Court of Protection decisions in 2016 and 2017. The Court, as is usual, had issued instructions, known as "transparency orders" prohibiting anyone from publishing personal information about KR's identity. But her long-term partner, Mr Stalter, had alledgedly breached these transparency orders on at least 25 occasion over a period of 2 years. So the Court was asked to send Mr Stalter to prison for contempt of court.
SR, an 83-year-old woman who had dementia, was subject to a standard DoLS authorisation in a care home. She had been married to JR for almost 60 years. The local authority wished to restrict contact between the couple on the basis that JR could not look after his wife safely. There were also concerns about JR's views in favour of euthanasia and whether those views would place SR in danger.
This case received some media interest as it concerned a young woman with autism and a learning disability who was deemed to have capacity to consent to sex, but not to have capacity to make decisions on her contact with men. The Judge said that these were two separate decisions, but to be honest we struggle to see how you could have one without the other.
The Supreme Court gave a ruling on whether decisions relating to the withdrawal of artificial nutrition & hydration from a patient in a vegetative state could be made by the doctors and families alone, WITHOUT having to go to court.
Sergei Skripal and his daughter Yulia were admitted to hospital in Salisbury in March 2018 having been allegedly the victims of a nerve agent attack carried out by Russia. The case received widespread publicity and led to a serious diplomatic row between the UK and Russia. The case that came to the Court of Protection concerned whether it was lawful for blood samples from the Skripals to be taken from them, and for those samples to be shared with other security services around the world in order to enhance our understanding of what had happened.
D was a soldier who had suffered traumatic head injuries as the result of an assault in a bar by another member of his regiment. The case was about whether it was in his best interests to to be taken to Serbia to receive stem cell treatment.
QZ was a woman in her 60s who had a longstanding diagnosis of chronic, treatment resistant, paranoid schizophrenia which was chiefly characterised by disordered thought patterns, paranoid behaviour and a ‘grandiose belief structure'. The issue was about investigating, and if necessary treating, her suspected cancer. The Judge criticised the "balance sheet" approach as being too simplistic for such a complicated decision.
An 81 year old woman had made an Advance Decision to refuse treatment, but this was misplaced by the hospital which led to her receiving artificial nutrition and hydration for 22 months.
CH and WH were a married couple who both had learning disabilities. When they sought fertility treatment a professional questioned whether CH (the husband) had capacity to consent to sex, and he was required to undergo a (much-delayed) programme of sex education.
IH was a 39 year old man with a profound learning disability, autism and challenging behaviour. This case looked at whether it was in his best interests to observe certain religious practices (fasting during Ramadan, and having his pubic and under-arm hair shaved), since he lacked the capacity to make those decisions for himself.
Case that went to the Supreme Court. N's parents wanted the CCG to provide a certain level of care for their learning disabled son, but the CCG argued (in part) that they had limited resources and could not fund this.
An interesting case where a 32 year old man with Prader-Willi Syndrome was reluctant to engage with professionals who were trying to assess his capacity to make decisions in relation to residence and care. An expert in PWS concluded he lacked capacity, whereas a social worker (who had less expertise in PWS) managed to establish more of a rapport with him, and concluded that he had capacity.
A complicated case where 3 teenage boys had been taken into care due to concerns that their mother (M) had brought them up in what amounted to a "cult" environment, with very limited contact with the outside world. Of particular interest was the assessment that J, who was almost 18, lacked the capacity to decide where to live - but the Judge criticised that assessment.
This case concerned a 20 year old woman with autism who engaged in what some people would see as "risky" or "unwise" behaviour. The question was whether the "riskiness" or "unwiseness" of this behaviour amounted to a lack of capacity on her part.
A woman wished to terminate her pregnancy. The father of the unborn child had assaulted her badly, leaving her with head and other injuries. Therefore there were questions about whether she had the capacity to decide to have the termination, and if not, whether a termination was in her best interests.
An application by the wife of a man in a minimally conscious state (following a road traffic accident) to stop his clinically assisted nutrition and hydration (CANH).
This case concerned the will of David Poole who had suffered severe head injuries in a motorcycle accident in 1985 and who then died in 2013. The will had been drawn up by his carer/landlord Mark Everall, and was contested by David Poole's brothers on the basis that David Poole lacked the capacity to make that will.
KA was a 29 year old man of Bangladeshi heritage, whose family wanted to arrange a marriage for him. The judge gave some useful guidance on how professionals should assess someone's capacity to marry and capacity to consent to sexual relations.
Court of Protection revoked the LPA of a woman with dementia whose son had taken large amounts of her money as "expenses".
A DNACPR notice was placed on the file of Elaine Winspear's son, Carl, who had various disabilities. Elaine Winspear was not consulted about this decision. Elaine Winspear argued, successfully, that this was a breach of her son's human rights.
A 50 year-old woman refused life-saving kidney dialysis treatment. She had lived the "high-life", but as she became older she felt her life had lost its "sparkle".
Whether it was in the best interests of a 43 year old woman, CD, who suffered from paranoid schizophrenia to have a total abdominal hysterectomy in circumstances where she lacked capacity to make that decision for herself. CD was, at the time, detained under the Mental Health Act.
A case which, amongst other things, gave guidance on how we might assess a person's capacity to consent to sexual activity.
JB, who suffered from paranoid schizophrenia and various physical health problems, had a gangrenous foot, which doctors recommended should be amputated. There was doubt about JB's capacity to make this decision, hence the court case. The court was critical of various comments made by professionals in their capacity assessments.
IA was a 59-year-old man with numerous serious health issues arising from his diabetes and latterly from a vicious criminal assault. The issues were his capacity to make decisions about his medical treatment, ongoing residence and care and management of property and affairs. The strenuous efforts made by professionals to help IA to make these decisions for himself (despite IA's frequent refusal to co-operate) were held up as an example of best practice under Principle 2 of the Mental Capacity Act.
LM, a 42-year-old female, had a long history of drug and alcohol abuse, and more recently brain damage after a cardiac arrest. She was in a relationship with AB. LM had been assessed by the Court of Protection as lacking the capacity to consent to sex, which meant that AB would be breaking the law if he were to have sex with her. AB challenged that assesment, so the case came to the Court of Appeal.
TZ was a 24 year old man with mild learning disabilities, atypical autism and hyperactivity disorder. He was deemed to have capacity to make some decisions, and to lack the capacity to make others, and the Judge here gave guidance on the importance of being careful about what decision is actually being assessed.
The court was considering whether PB had the mental capacity to decide whether to live with her husband, TB. And if PB lacked capacity, was this caused by a material impairment or disturbance of the mind or brain, or did it stem from the influence exercised over her by her husband - coercive control? Because if it stems from coercive control alone then that cannot equate to a lack of mental capacity under the Mental Capacity Act.
A patient who was an asylum seeker and who was detained under the Mental Health Act went in hunger strike to force the authorities to return his passport to him. The Court had to rule whether it was lawful to force-feed him, and if so under what legislation?
LP, a female, had left her husband and adult children to set up a new life with a different partner. She severed all contact with her "old" family. They eventually tracked her down to a care home where she was living following a stroke. She lacked the capacity to decide whether to have any contact with the "old" family, so the case was about whether it was in her best interests to do so.
PC, a 48 year old woman with a mild learning disability, had established a relationship with NC, a man, in 2001. They had lived together for a while before NC had been sent to prison for 13 years for serious sexual offences, not involving PC. PC and NC had married in 2006, whilst he was serving his prison sentence. With NC coming to the end of his sentence, professionals were worried about the risk he might pose to PC if they were to co-habit. The Court of Protection ruled that PC lacked the capacity to make that decision. PC and NC disputed that capacity assessment, so the case went to the Court of Appeal.
RG, a man with learning disabilities, had undergone an arranged marriage in India with SK. The couple now lived in England and there were concerns about whether they should remain married, and whether they should continue to have sexual relations.
Mr James had suffered a stroke, cardiac arrest and multiple organ failure and was being kept alive by clinically assisted nutrition & hydration (CANH). The question was therefore whether it was in his best interests to keep him alive, or to withdraw the CANH. The case went to the Supreme Court.
- "Woman with limited mental capacity can have her baby" (headline from the Independent newspaper, 2013)
The case concerned a young woman with learning disabilities who was 18 weeks pregnant. Professionals were concerned about her ability to decide whether or not to have the baby, and how to care for the baby once it was born.
A 37 year old woman with a history of bi-polar disorder, who was 23 weeks pregnant, wanted a termination.
A 35 year old woman with a history of psychotic mental illness was pregnant. Doctors believed she should have the baby by Caesarean Section due to the danger to mother and baby, but she refused. The Court allowed her full name to be published.
The parents of 21 year old woman with learning disabilities were concerned about the possibility of her becoming pregnant, so they sought permission to have her sterilised.
This was a complicated case in which a woman with learning disabilities (PM) had married a man who did not have learning disabilities. There were concerns that this was a "marriage of convenience" to overcome his immigration problems. The court had to rule on the validity of the marriage, and on the woman's capacity to consent to sex with her husband, and where she should live. There was also the welfare of an 18 month old baby to consider.
A 36 year old man with learning disabilities was in a relationship with a woman, which had produced a child. The pregnancy, and subsequent birth, had been very traumatic for both of them, and it was assessed that they lacked the capacity to decide to go through with another pregnancy. The question, therefore, was how to prevent a future pregnancy happening - and sterilisation of either or both of them was being considered.
L, a 30 year old man with learning disabilities, was considered to be very much on the borderline between having, or lacking, the capacity to decide on residence, care and contact. The Judge gave some very useful guidance on what is, and is not, relevant in assessing capacity on these issues.
A complicated case where judgements were needed on X's capacity to marry, make a will, revoke or grant an enduring or lasting power of attorney, manage his affairs and litigate.
DL, a man of around 50, was accused of bullying and controlling behaviour towards his parents who were aged 85 and 90. The local authority stepped in to protect them under Safeguarding arrangements. DL argued that the local authority had no right to do this as his parents had capacity. The Court of Protection, and then the Court of Appeal, ruled that it had the inherent jurisdiction to protect vulnerable people, whether or not they had capacity.
E, a 32 year old woman, had a severe eating disorder, borderline personality disorder and substance dependencies. She was close to death, having not eaten any solid food for over a year. She had previously made an Advance Decision to refuse life sustaining treatment. The Court had to consider whether she had had capacity when she made that AD, whether she had capacity now, and if not, would it be in her best interests to feed her against her will?
Members of a band which was referred to in court as "MY" had a chart hit in the 1980s called "Pass the Dutchie". Many years later they sued their then legal advisors for what they said was poor advice on marketing rights. One of their complaints was that one member of the band, FW, had been suffering from paranoid schizophrenia at the time, and therefore did not understand the contract that he was signing.
A 29-year-old woman with learning disabilities and autism, living in supported accommodation, was engaging in sexual behaviour that was considered to be harmful to herself. In particular, she felt she had a duty to submit to sex, and did not appreciate that she could say "no". The Court had to consider whether she had capacity to consent to sexual activity, and also how to manage the situation.
The relationship between Guardianship under the Mental Health Act and DoLS under the Mental Capacity Act
An application by HN to have her sister, FL, moved from a care home in Hampshire to one in London so that HN could see her more often.
- "Brain-damaged woman denied right to die in landmark ruling" (headline in the Independent newspaper, 2011)
M was in a "minimally conscious state" after a viral encephalitis. Prior to her illness she had made it clear verbally to family and friends that she would not ever want to be reliant on life support. But she had never put those wishes in writing, so the Court had to decide whether to continue the life support, or to withdraw it.
AB was a 41 year old man with a mild learning disability, and the issue was whether he had the capacity to consent to sex. The Court gave some guidance on how to assess capacity in such a case, but please note that this guidance was revised by the later case of London Borough of Tower Hamlets and TB in 2014 (see above).
PS was a 55-year-old woman with a learning disability who had been diagnosed with cancer. It was accepted that she lacked the capacity to decide how to deal with this. In particular, she had a fear of needles and of hospitals, so it was very difficult to persuade her to go to hospital for treatment.
The local authority (LBL) sought a declaration that a young adult female (RYJ) lacked the capacity to make various decisions about her life. The Judge gave some guidance on what is, and is not, relevant in assessing capacity, and also gave guidance on how the Court's inherent jurisdiction might apply.
Until this ruling virtually all Court of Protection cases were held in secret and not reported. This ruling allowed the media to attend and report on CoP cases, without which we would not have been able to compile the database you are now looking at.
P, a 24 year old man with a mild learning disability and severe uncontrollable epilepsy had a difficult relationship with his adoptive mother, AH. It was a case of they couldn't live together, but neither could they live apart. The case was about whether P had the capacity to decide where and with whom to live, and if he lacked capacity, what should happen.
An early Mental Capacity Act case which centred on whether MM had the mental capacity to decide to spend time with a man who often encouraged her to sleep rough and stop taking her medication. The Judge (Mr Justice Munby) posed the now-famous question: "What good is it making someone safer if it merely makes them miserable?"
Just before the Mental Capacity Act became law, but an interesting case where a 25 year old man with autism and learning disabilties was about to be taken to Pakistan for an arranged marriage. The local authority intervened, and took the case to court on the basis that MAB lacked the capacity to consent to sex, and lacked the capacity to consent to marry.
A landmark ruling that paved the way for the Mental Capacity Act more than a decade later. Harry C was a patient in Broadmoor Hospital who had a gangrenous infection in his leg. However he refused to allow the doctors to amputate it, which they felt was necessary.
Well before the Mental Capacity Act came in, but still relevant today even so. It's about whether a young person who is not yet 16 can nevertheless demonstrate sufficient maturity about making a decision about their own life.