The Court of Protection is the 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 interesting rulings of the Court relating to the main Mental Capacity Act (there is a separate list relating to deprivation of liberty). 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.
A few of the cases below involve “inherent jurisdiction” which is where the Court thinks that it needs to act, but there isn’t a piece of legislation that covers this specific issue.
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. And if you would like to observe a hearing then click here for details of how to do so.
This is a significant ruling which said that ALL decisions about medical treatment MUST be made in the patient’s best interests, even if treating clinicians feel that treatment is futile.
The main feature of this case was the professionals’ failure to consult with the Lasting Power of Attorney
This case was about whether a “borderline intellectual functioning” would count as an “impairment or disturbance in the functioning of the mind or brain” for the purposes of assessing mental capacity. The case also has elements of domestic abuse/coercive control. Alex Ruck Keene has published a detailed analysis of this ruling too.
Quite a complicated case, but it focusses on whether residence and care/support decisions can be viewed as one combined decision, or 2 separate decisions
This is about whether an elderly woman with dementia, depression and hoarding disorder has the mental capacity to marry.
Although not particularly complicated in itself, this is a helpful reminder of how the “communication” limb of the test for mental capacity should be applied.
This is a blog from the Open Justice Court of Protection Project concerning a long-running case where a woman does not approve of her daughter (who has paranoid schizophrenia) living in a care home. The mother has repeatedly breached court orders that she must not post information online about her grievances.
This is a long-running case where the local authority is concerned that MB is being coercive and abusive to his husband, SV. Both men have learning disabilities.
Whether a 32-year old woman with a learning disability and autism has the mental capacity to engage in sexual relations and to enter a marriage or civil partnership.
How to care for an adult with anorexia, and in particular is “force-feeding” appropriate?
A surprisingly rare case looking at the validity, or otherwise, of an Advance Decision to Refuse Treatment.
The issue here was that a 72-year-old man was near the end of his life, and his will (from 11 years previously) was in favour of his then-partner, contrary to his current wishes.
This was about whether to continue to give artificial nutrition & hydration to someone in the context of a devout Muslim man.
This concerned a woman in her 30s with a learning disability (who was given the name “Stitch” in court as it was her favourite Disney character). The case concerned compulsory care plans and fluctuating mental capacity.
The issue here was whether CT’s lack of insight into his condition was relevant to the question of whether he had capacity to make various decisions about his life.
This case covered the limits of inherent jurisdiction
Whether the Deputy for a young man with a brain injury could use his compensation money to pay off drug debts.
KZ was profoundly deaf, and the Judge stressed the importance of his capacity being assessed by a professional who had expertise in assessing deaf people.
A case where a mother was reluctant to allow professionals to assess the mental capacity of her 19 year old daughter because she felt it would be too distressing for her.
CA was a 79-year-old woman living with Alzheimers, who had a turbulent relationship with her daughter and with her daughter’s ex-husband. The local authority was worried about CA continuing to have contact with them.
This concerned a woman in her 50s who lived with Dissociative Identity Disorder and whose mental capacity to make various decisions fluctuated. She frequently went missing from home, during which she may have been assaulted, but she said it was a different identity who had been the victim.
A 79-year old female care home resident wished to continue her sexual relationship with her long-term partner. The question was whether she had the mental capacity to engage in sexual relations.
This was about whether an 18-year-old man had the capacity to engage in sexual relations. He had made disclosures to therapists and social workers which caused them to be concerned about the harm that he posed to others. Neither the Mental Health Act, nor the Criminal Justice System, could be used.
J, a 17-year-old, was refusing to consent to having a blood transfusion, based on his religious belief. There was no question that he had the mental capacity to make this decision, but because of his age his refusal does not automatically prevail.
The Court of Protection had originally ruled that because Sudiksha did not BELIEVE the doctors who told her that her medical condition was incurable, that must mean she lacked the mental capacity to make decisions about her medical treatment. The Court of Appeal said this was wrong. This story was picked up by BBC news.
A 35-year-old woman who was pregnant and detained under the Mental Health Act. The hospital trust sought a declaraton that it would be in her best interests to have a termination.
CLF was a young woman with learning disability and autism, and there was dispute about her capacity to make various decisions about her life, each of which impacted on each other.
The Court of Protection had recently made an order that it was NOT in the best interests of J (a man in his 20s with severe learning disabilities) to travel to Afghanistan for a holiday. His family appealed that decision.
A 31-year-old woman with various conditions wished to become pregnant, so there were questions about her capacity to make decisions about sex, contraception and contact with others.
A young woman had previously been assessed as lacking the mental capacity to make various decisions, but at the latest hearing, and after discussions with her social worker and other professionals, the psychiatrist changed her mind and concluded she DID have capacity currently.
A 73 year old man was refusing to have the proposed medical treatment, and lacked capacity to make that decision. The interesting feature of this case concerned how much to tell the man in advance about what was going to happen.
This case related a woman diagnosed with OCD and Hoarding Disorder. Professionals had attempted to engage with her over many years because they were concerned about the health and fire risks to herself, and to her neighbours, from her extreme hoarding.
This was a family dispute where an elderly woman had revoked the LPA of two of her children, deciding instead to give sole power to one child. The other two children argued that this was invalid because their mother lacked the mental capacity to make that decision.
A young man with a troubled history and a conviction for a serious sexual offence against a child. There was a lack of clarity over his diagnosis and dispute about his mental capacity to make a variety of decisions about his own life.
This case revolved around whether a 36 year old man with severe learning disabilities and autism should have extensive dental treatment in his best interests. There’s a good discussion of whether the treatment would be compatible with various Human Rights.
Jordan (his real name, with his parents’ permission) is a 29 year old man with autism and severe learning disabilities. The hospital was opposed to treating his kidney issue with dialysis, but the Court ruled that it should go ahead.
A 34 year old man with learning disability and autism was challenging the assessment that he lacks the mental capacity to make decisions about engaging in sexual activity.
ST, a 19 year old woman with a life threatening condition, (which she did not accept that she had) wanted to continue medical treatment, against medical opinion. The question was whether she had capacity to decide about treatment, given that she did not have a diagnosis of mental disorder.
RK, a 30 year old woman with a learning disability (who was an accomplished swimmer and TV actor) had fallen out with her family over a relationship with a man, and had ceased contact with them. The family wanted the Court to rule that she lacked the mental capacity to do this, or if she had capacity they wanted the Court to use its inherent jurisdiction to re-establish contact.
“Tony” was a man in his 50s who was believed by his carers to have a learning disability. However there was a dispute about this, and he had never been formally diagnosed as having one. So the issue was whether he had an “impairment or disturbance in the functioning of the mind or brain” for the purposes of a Mental Capacity Act assessment. There’s an excellent discussion of the issues by Alex Ruck Keene here.
A disabled prisoner was on a “soft food” diet. He wanted prison staff to feed him boiled sweets, biscuits and crisps, and claimed that, as he had the mental capacity to make decisions about his own food intake, the staff were acting unlawfully in refusing.
There was genuine dispute between professionals as to whether this young woman (with autism and acquired injuries) had the mental capacity to make care and residence decisions. The dispute was largely around Y’s executive functioning.
A mother had been ordered by the Court of Protection to stop videoing her daughter and her daughter’s social care workers. The mother carried on doing do, in breach of the order, and was therefore given a suspended prison sentence. She appealed against the conviction and the sentence, hence this hearing in the Court of Appeal.
RB was a 29 year old woman with Autism, was electively mute, choosing to communicate in writing only or pointing at words or letters. She was deemed to be fit to be discharged from hospital but refused to leave.
A man serving life imprisonment was refusing food, and then stopped communicating verbally with professionals.
A 17 year old woman initially detained under S2 Mental Health Act, now medically fit for discharge, but no suitable placement available for her. So under what piece of legislation could she continue to be detained? In the jargon, this is an example of “Case E” in practice.
There was disagreement amongst professionals over whether a 34 year old woman with various diagnoses had the mental capacity to make decisions about care, and contact with others. Her capacity fluctuated depending on whether she was calm and composed, or whether she was anxious and/or under the influence of alcohol.
Whether a pregnant woman, R, had the mental capacity to decide about having a Caesarean Section. R did not have a formal diagnosis of mental disorder.
In 2022 the Court of Protection had made various rulings in respect of FP, described as a “highly vulnerable woman” in her early 30s who had Cerebral Palsy and paranoid schizophrenia. Her mother had defied Court orders not to interfere with professionals, not to disclose FP’s identity publicly, not to record her on video. Therefore the Council wished for the mother to be imprisoned for breaching these orders. The mother eventually appealed against the Court of Protection’s ruling.
A 16 year old girl was 39 weeks pregnant and her capacity to make decisions about the birth had begun to fluctuate – she had become very distressed at the point of having the (previously agreed) C-Section.
The family of a 40 year old man with learning disabilities and schizo-affective disorder was blocking professionals’ attempts to provide suitable care and support to him in his home. So the question was, should he be moved to a supported living project in order to have access to better life chances?
A 26 year old woman with a set of complex diagnoses and a long history of self harm. She had fluctuating capacity to make decisions about her medical treatment, in particular a tube into her throat to help her breathe.
A complicated case involving a 23 year old woman who had been removed from her family home against the wishes of the woman and her mother, and whether covert medication was necessary to treat her serious medical issues, and whether her mother should know that she was being given covert medication.
A case where professionals were concerned about the influence that TT’s mother was exerting on his life. The Court used its inherent jurisdiction.
AC, a 92-year-old woman with Alzheimer’s and alcohol-related brain damage was living at home with her son, GC, who had Asperger’s, anxiety, OCD and depression. Both had been diagnosed with having a hoarding disorder, and the issue was how best to care and support both of them.
DN was 17 years old, autism, and complex behavioural needs. His residential school had concluded they could no longer accommodate him, so they gave 6 weeks’ notice. The local authority struggled to find an alternative placement.
KF is a 34 year old woman with a learning disability, in a long-term relationship with a man, KW. There were several recent incidents of him assaulting her during sex, necessitating hospital treatment. He was due to be sentenced in the next few days for one of these assaults, and was expecting a prison sentence. KF wished to spend time alone with him before sentencing. She was deemed to have the mental capacity to decide to engage in sexual activity, but did that mean that she specifically had the mental capacity to decide to engage in sexual activity with KW? There is an excellent discussion of the case from the Open Justice project here.
Whether an 86 year old woman with Alzheimer’s and various physical conditions should continue to live in a care home, and continue to have contact with her children, with whom there was a very fractious relationship.
This was a dispute about whether a man with schizophrenia and a learning disability had had the mental capacity to appoint his mother and brothers to be his Lasting Powers of Attorney some 13 years previously.
A 50 year old woman with severe epilepsy and mild learning disabilities was deemed to lack the mental capacity to consent to having a COVID vaccination. Her family, especially her sister, were firmly opposed to her having it, and argued that if she had capacity she would refuse it.
E, a man in his 60s, lacked the mental capacity to consent to having the COVID vaccination. One of his siblings was strongly opposed to him having it, and enlisted the support of a doctor, who himself is strongly opposed to the vaccination.
Whether an 18-year-old woman with various mental health issues should be allowed to move permanently to Brazil to continue a relationship with a much older man there. This case illustrated the limits of the inherent jurisdiction of the Court.
Concerns about whether a wife should have contact with her husband of 40 years, given concerns that he was being coercive and controlling towards her.
“Peter” was a man with ASD, Tourette’s and learning disabilities, who was detained under the Mental Health Act and was subject to restrictions that were beyond those which were “usual” for people detained under the MHA. So the Court explored whether DoLs was needed also.
A 38 year old woman with bi-polar, detained under the Mental Health Act, was voicing doubts about going through with the birth at 23 weeks.
P was a 21 year old woman who had been removed from her parents’ home by police in a state of extreme neglect, malnutrition and poor health. This had generated considerable interest in the media. Given that she was deemed to lack capacity to make decisions about her care, residence and future contact with her parents, those decisions had to be made for her in her best interests. But first the Court had to consider whether to allow the public to observe the hearing, and whether to allow details of it to be made public, or whether this would be unreasonably distressing for P.
DC, a 20 year old man, lacked capacity to consent to having the COVID vaccination. His parents had done considerable research and were opposed to him having it (they were not antivaxxers as such).
Whether an 86 year old man, with advanced dementia, should remain in his current care home, or move to a Jewish one for the final years of his life
Whether a 17 year old with severe LD and autism should be given the COVID vaccine. Part of this case revolved around his father trying to bargain with the Court along the lines of “I will allow him to have the vaccination if you allow him to live with me …”.
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.
Not the Court of Protection, but a case where a child who was almost 16 was refusing a blood transfusion, and whether the Court could overrule the child’s wish. Gillick Competence was questioned here.
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 53. BU’s family was very concerned that NC exerted coercive control over BU. NC had a string of previous serious convictions, including dishonesty.
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. Executive capacity was an issue here.
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.
How the concept of fluctuating capacity relates to sexual relations, and the danger of setting the bar too high.
An 87 year old woman (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.
Aamir Mazhar, a 26 year old man with Duchenne Muscular Dystrophy, had been removed from his family home under the inherent jursidiction of the High Court because of concerns about the way in which his family was (not) caring for him. Mr Mazhar complained to the Court of Appeal that this decision was wrong because he HAD the mental capacity to make decisions for himself about care and residence, and because he had not been given the opportunity to put his views forward in the origival hearing.
GP was a 19 year old man with autism and other conditions. His father did not want professionals to be involved in his life, so the issue was firstly whether GP had the mental capacity to make decisions about accepting or refusing services, and secondly if he didn’t, was it in his best interests to be assessed as to his needs.
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.
R was a pregnant woman detained under the Mental Health Act. There were concerns that her mental health might cause her at the point of birth to lack the mental capacity to make decisions about the birth. Therefore the Court used S15 (1) (c) of the Mental Capacity Act to make a “prospective order” of what could be done if that were to happen (even though she has the relevant mental capacity currently).
Guidance issued by the Court of Protection on serious medical treatment. May eventually be superceded by the new Code of Practice.
This case had started in the Court of Protection as A Local Authority v BF [2018]. It concerned a 97-year old blind man with diabetes and osteoarthritis who lived with his drug-addicted son in squalid and dangerous conditions. The case was whether it was justified to use inherent jurisdiction to remove Mr Meyers, or his son, in order to protect Mr Meyers. The BBC picked up on this story.
Another self neglect case where the issue was whether to use the Mental Capacity Act or the Inherent Jurisdiction of the High Court in order to protect a vulnerable man.
VT was a young man with severe global delay and other physical health problems whose keyworker formed a close relationship with him. The CCG was unhappy that this relationship continued once VT had moved to new accommodation and sought to terminate it. The Court was heavily critical of the CCG’s flawed approach and awarded costs against them.
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 [2019] EWCOP 26, (see below) 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) [2019] 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. The Judge on Friday ruled in favour of a termination, but that decision was overturned by the Court of Appeal the following Monday (Re AB (Termination of Pregnancy) [2019] EWCA Civ 1215)
What to do about a man who had diabetes, epilepsy, poor mobility, was incontinent, drank alcohol heavily and was unable to maintain his home environment. Was the Mental Capacity Act, or Inherent Jurisdiction, the right way forward?
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 that 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.
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 [2019] 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.
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.
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 allegedly 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.
A 63 year old woman with a personality disorder had fluctuating capacity to make decisions about how to manage her diabetes.
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.
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.
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.
A man with learning disabilities, epilepsy and autism was found to have fluctuating capacity in relation to residence, care and contact decisions.
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 trimmed), 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.
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.
A very unusual case where a woman’s serious mental disorder rendered her unable to make decision about receiving HIV treatment (she was HIV positive). Her mental disorder caused her to believe that she was starring in a film, playing the role of a woman who was HIV positive. The debate was about whether it would be lawful and ethical for professionals to “play along” with that delusion in order to administer the HIV treatment. In other words, would active deception be justified in AB’s best interests?
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. There’s a helpful discussion of the issues in this case from 9 Gough Chambers here.
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.
This was a woman with learning disabilities who had already had 6 children, and whose life was considered to be in danger if she were to become pregnant again.
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.
A 22 year old woman who was assessed as having fluctuating capacity to consent to sexual relations. Therefore the Court couldn’t make a best interests decision, but the Judge ordered the matter to be kept under “careful review”.
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.
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. This guidance has been used regularly over the years as a pointer for other difficult cases.
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.
A British woman with severe learning disabilities had undergone an arranged marriage in Bangladesh, and had then returned to the UK with her husband. The Court used its inherent jurisdiction to issue a “non-recognition declaration” – ie to declare that the marriage was not valid in the UK.
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?
This was a claim made by members of a 1980s band called Musical Youth. 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 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.
A tribunal decision, rather than the Court of Protection, revolving around whether a young woman with profound learning and physical disabilities was entitled to housing benefit if she wasn’t able to sign a tenancy agreement.
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.
A complicated case concerning a 75 year old woman with various health and social care needs. Professionals, including occupational therapists, had proposed a package of care to meet those needs, but the woman and her husband disagreed about what care was most appropriate for her.
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.
This case focussed on how you might assess whether someone has the mental capacity to make decisions about contraception.
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 29 year old woman with a history of mental illness and an abusive relationship with her father. She had fluctuating capacity to make decisions about having contact with her family.
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.
Gave some guidance on how Gillick competence could apply to the refusal of medical treatment (in this case anti-psychotic medication)
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 receiving advice about contraception, and not telling their parents about that advice. In July 2025 the Court of Appeal ruled that Gillick competence can only apply to the question of whether someone under 16 can consent to, or refuse to consent to, medical treatment.
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