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Re T (Adult: refusal of medical treatment) [1992] 4 All ER 649, (1992) 9 BMLR 46 (CA)

Court decision

The court granted a declaration that in the circumstances it would not be unlawful for the hospital to proceed with the transfusion, despite the absence of her consent, because this would clearly be in the patient's best interests. It was decided that Miss T was very much under the influence of her mother and that, even though she was a competent individual, she had been coerced into making her decision by her mother. Lord Donaldson MR said:

"A special problem may arise if at the time the decision is made the patient has been subjected to the influence of some third party...the doctors have to consider whether the decision is really that of the patient...The real question in each such case is 'Does the patient really mean what he says or is he merely saying it for a quiet life, to satisfy someone else or because the advice and persuasion to which he has been subjected is such that he can no longer think and decide for himself?"

The court decision here is based on undue influence, which has caused the patient to refuse treatment. Her decision was invalid, because it was based solely on the persuasion of her mother. The judges also considered whether, if she was a Jehovah's Witness herself, then would this have made her decision legally effective. They decided that under those circumstances, her decision would have been effective, and Lord Donaldson said:

"[A patient's} right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent...That [the patient's] choice is contrary to what is to be expected of the vast majority of adults is only relevant if there are other reasons for doubting his capacity to decide. The nature of his choice or the terms in which it is expressed may then tip the balance."

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