In Re S. (Adult: Refusal of Treatment) [1992] 3 W.L.R. 806
Family Division

Sir Stephen Brown P.

1992 Oct. 12

Medical Practitioner - Medical treatment, consent to - Refusal of Caesarean section - Adult woman in obstructed labour - Lives of mother and unborn child at risk - Refusal of consent to Caesarean section on religious grounds - Whether declaration to be granted enabling operation to be performed

An adult woman had been in labour for more than two days with her third child. The pregnancy was at full term. Labour was obstructed and the lives of mother and child were at risk. There was evidence that in order to save both lives it was necessary to perform a Caesarean section on the mother. Both she and her husband refused consent to the operation on religious grounds.
On an application by the health authority for a declaration that the operation could be performed lawfully without the mother's consent:-
 

Held, granting the declaration, that in a situation in which the lives of mother and the unborn child would both be at risk if the operation were not performed, it was open to the court to make a declaration that the operation could be performed notwithstanding the mother's refusal of consent.

A.C., In Re (1990) 573 A.2d 1235 T. (Adult: Refusal of Treatment), In Re [1993] Fam. 95; [1992] 3 W.L.R. 782, C.A..

ORIGINATING SUMMONS
By an originating summons, dated 12 October 1992, a health authority sought a declaration that a Caesarean section could be performed on a patient, Mrs. S., who was refusing consent to the operation. The hearing was in chambers and is reported with consent of Sir Stephen Brown P.
The facts are stated in the judgment.

Representation

Huw Lloyd for the health authority.
James Munby Q.C. as amicus curiae.

SIR STEPHEN BROWN P.
This is an application by a health authority for a declaration to authorise the surgeons and staff of a hospital to carry out an emergency caesarean operation upon a patient, who I shall refer to as "Mrs. S."
Mrs. S. is 30 years of age. She is in labour with her third pregnancy. She was admitted to a London hospital on 10 October 1992 with ruptured membranes and in spontaneous labour. She has continued in labour since. She is already six days overdue beyond the expected date of birth, which was 6 October 1992, and she has now refused, on religious grounds, to submit herself to a Caesarean section operation. She is supported in this by her husband. They are described as "Born Again Christians" and are clearly quite sincere in their beliefs.
I have heard the evidence of the surgeon, who is in charge of this patient at the hospital. He has given, succinctly and graphically, a description of the condition of this patient. Her situation is desperately serious, as is also the situation of the as yet unborn child. The child is in what is described as a position of "transverse lie;" with the elbow projecting through the cervix and the head being on the right side. There is the gravest risk of a rupture of the uterus if the section is not carried out and the natural labour process is permitted to continue. The evidence of the surgeon is that we are concerned with "minutes rather than hours" and that it is a "life and death" situation. He has done his best, as have other surgeons and doctors at the hospital, to persuade the mother that the only means of saving her life, and also I emphasise the life of her unborn child, is to carry out a Caesarean section operation. The surgeon is emphatic. He says it is absolutely the case that the baby cannot be born alive if a Caesarean operation is not carried out. He has described the medical condition. I am not going to go into it in detail because of the pressure of time.
I have been assisted by Mr. James Munby, appearing for the Official Solicitor as amicus curiae. The Official Solicitor answered the call of the court within minutes and, although this application only came to the notice of the court officials at 1.30 p.m. it has come on for hearing just before 2 p.m. and now at 2.18 p.m. I propose to make the declaration which is sought. I do so in the knowledge that the fundamental question appears to have been left open by Lord Donaldson of Lymington M.R. in In Re T. (Adult: Refusal of Treatment) [1992] 3 W.L.R. 782, and in the knowledge that there is no English authority which is directly in point. There is, however, some American authority which suggests that if this case were being heard in the American courts the answer would be likely to be in favour of granting a declaration in these circumstances: see In Re A.C.(1990) 573 A.2d 1235, 1240, 1246-1248, 1252.
I do not propose to say more at this stage, except that I wholly accept the evidence of the surgeon as to the desperate nature of this situation, and that I grant the declaration as sought, which will include provision for the necessary consequential treatment in addition to the Caesarean operation.

Representation

Solicitors: Beachcroft Stanleys; Official Solicitor.

Declaration accordingly. No order as to costs. (M. B. D.)

(c) Incorporated Council of Law Reporting For England & Wales
[1993] Fam. 123