Agoraphobic mum-to-be forced to go to hospital for the birth

I can see how someone with a phobia that is likely to prevent them from accessing life-saving treatment could be judged to lack the capacity to make decisions about a situation when this is more likely than usual to be required.

I've been in that situation. Luckily the HCPs working with me recognised that simply making a different decision to them did not mean I lacked capacity, documented that capacity and supported me with a legally binding advance directive to protect me from anyone else coming along to try and do what has been done to this woman to me.

I bet the HCPs involved in this case when she's left severely traumatised, unable to trust anyone or feel safe anywhere will all wash their hands of her and leave her to suffer the hell they are responsible for inflicting.

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard.

That is not how it is supposed to operate legally but when it comes to mental health patients it gets abused.

Giving someone lifelong PTSD is not in their best interests.

The 'force thing' is important because it allows the emergency services to remove the woman from the home, if she will not go willingly. It does not mean that they will use physical force in the normal sense, which I am sure they will avoid if humanly possible. Normally, though, a police officer or paramedic could not even gently take someone by the elbow and lead her out against her will (unless she were under arrest, in the case of the police). It's very difficult - rightly - to remove someone from their own home legally, which is why the Court needed to specify that is was allowable in this case.

I think it depends on what risks they say can happen. a judge would not agree to this without their being evidence. Although if she’s been stuck at home for years then I imagine social services will place the baby into care as it’s neglect to keep a child inside constantly. What will she do when the child goes to nursery or school? Keep them at home. She needs a home birth with a midwife and doctor but she also needs a lot of help.

The Act specifically says that someone must not be deemed to lack capacity just because they are making an unwise decision!

Judges make awful decisions especially when it comes to women all the time. I find it interesting there's so much faith in the system being shown on the thread.

That is true
But those of us that deal specifically with the court of protection know that they in general uphold the rights of people to make unwise decisions and don’t make decisions lightly that deprive people of their liberty

The PTSD they cause by forcibly removing her from her home and forcing her to give birth in a frightening environment she won't have any right to leave will hardly help her.

I question the conclusion that her disagreeing with her partner about where to give birth proves she does not have capacity to make that decision.

Having capacity brings the right to make unwise decisions that others wouldn't. It is not permitted to use those free decisions as "proof" of incapacity. She should have the right to accept the risk of her life ending by refusing any and all medical care, even where the reason for her refusal is how traumatic the care would be to receive.

Lazy traumatising coercion is the NHS's default approach to psychological distress. Creating traumatised broken people who can't live their lives.

You have not saved a person's life if in the process you inflicted so much trauma they can never live that life.

I have little faith in this judgment. Judgments can be wrong.

Then 'capacity' is a weak and fairly meaningless concept. We do not like your particular decision or intention. In fact only someone mad would make it. You aren't mad [enough to be locked up for reasons of mad] but will be compelled [by force if necessary] in this regard.
Not a slippery slope at all.

There must be a better way to deal with this and a home birth would surely be better, with a midwife she knows.

One of the safeguards of home birth is the option to be moved quickly to a hospital should circumstances require it. If this woman would be likely to refuse in such circumstances, that safeguard is no longer in place. Refusing emergency treatment at such a time could result in her death.

I can see how someone with a phobia that is likely to prevent them from accessing life-saving treatment could be judged to lack the capacity to make decisions about a situation when this is more likely than usual to be required.

It's awful but this decision could very well be the right thing for her.

I also don't see why her mother or partner's opinion is of any relevance in the slightest confused it should be between her and her midwife and/or consultant.

It’s in the mental capacity act 2005
When determining what is in the best interests of someone who lacks capacity to make a particular decision, those close to the person have to be consulted and their views taken into account.

There’s a lot of reading between the lines here- if scans have been provided at home it does seem like she’s been given at least some tailored support with respect to her circumstances.

I hope it works out as best as possible for her- I’m not going to say that it’s poor reporting due to the lack of detail, as behind all this there’s obviously a very scared young woman and a concerned family who deserve privacy to work their way through this.

Why on earth don't they say. We'll come round and sedate you

Er, because it's fucking dangerous to sedate anyone outside a clinical environment, let alone a woman in labour.

It's a shame if there could be a better way to do this for her, that perhaps could be the turning point for her and that may even help her overcome her phobia. I'm really sad to think this is likely to make things even worse for her and perhaps leave her with other issues too.

I do agree that sometimes there are no easy options and it is in her best interests to make sure that both she and her baby are ok but I just wonder how this could be done differently.

but very few people really think that, either for themselves or for others

If (for example) she has placenta praevia, a home birth definitely wouldn’t be better because she and the baby will 99.9% both die.

Actually, to be fair, if someone is a purist who believes in autonomy above all else this might be the “best” outcome for someone who has capacity and is intent on this.

It's reasonably likely that she will have a caesarean on that day, rather than waiting around in hospital for weeks?

@humanitariancisis yes. Good point.

I cannot understand the idea of her having to spend potentially weeks in hosp.

And the force thing.

Need more info. I am unwilling to say well a judge said it so it's fine without knowing more. Which I doubt we'll get.

There must be a better way to deal with this and a home birth would surely be better, with a midwife she knows.

You cannot say this without knowing the circumstances of her health and pregnancy.

If (for example) she has placenta praevia, a home birth definitely wouldn’t be better because she and the baby will 99.9% both die.

Having seen how courts in the uk condone abuse of women in family law, I don’t have faith in the system.

There must be a better way to deal with this and a home birth would surely be better, with a midwife she knows.

I think we need to be clear about what 'mental capacity' means, as this is a specific legal term, related to the Mental Capacity Act.

Firstly, capacity refers to a specific decision at a specific time. In this case, the decision to go to hospital or stay home for the birth. When you do a formal capacity assessment, you assess a person's ability to take that specific decision. It's not a judgement about that person's ability or thinking as a whole.

For someone to have capacity to make a decision they need to show that they:

• understand and can remember information related to the decision
• weigh up the information to come to a decision
• communicate their decision

So if this woman had been able to say "Yes, I understand that a home birth is risky to me because of [medical reasons eg breach position] and it would be safer to give birth in hospital. However, I would be so distressed by going to hospital that I would prefer to take the risk of me/my baby dying," then there is no way that s judge would make the decision that she had to attend hospital. There must be more going on that we're no privy to - because it's private.

Also, capacity to take decisions can change over time. It's possible that this woman currently has another mental health condition that is impairing her ability to make decisions. So she may absolutely have had capacity to consent to having sex, but may now be more unwell and not able to make a reasoned decision about where to give birth.

Related to that, many women stop taking medication for mental health conditions during pregnancy and when breastfeeding because they are worried that it may harm their baby. That can safely occasionally have very tragic consequences, if that causes a major relapse in their mental health condition.