In Manchester University NHS Foundation Trust v DE  EWCOP 19, DE was a 49-year-old woman who suffered from autism and mild learning difficulties: she and her mother were Jehovah’s Witnesses . In April 2019, DE broke her leg, and the medical evidence was that she needed surgery and that there was a risk that she would require blood transfusion or blood products during the operation . If she did not have the operation, her mobility would be impaired  and the need for an operation was urgent .
As to her religious beliefs, the evidence from the medical team was as follows:
“12. DE’s Mother’s position was that she was a committed Jehovah’s Witness and she did not believe that it was in DE’s best interests to have a blood transfusion because it was contrary to the beliefs of Jehovah’s Witnesses. Dr Chernik told me that KE had told him DE would not accept blood products.
13. In terms of DE’s wishes and feelings Mr Wheelton had asked her about the operation and she had said that she wanted the operation. When he asked her about having a blood transfusion she said that she was a Jehovah’s Witness. She had expressly said to him that she did not want to die.”
“14. The evidence at the oral hearing on DE’s beliefs and her commitment to the Jehovah’s Witness religion was fairly scant. She attends services, but her mother described her as not being a practising Jehovah’s Witness. She can recite the scriptures, but I got no sense of the degree to which she understood them or believed them or the degree to which they played an important part in her life.”
The Official Solicitor supported the operation: “His attendance note records that DE said that she was a Jehovah’s Witness but made it very clear that she wanted the operation to happen as soon as possible. She could not explain why blood transfusions were prohibited under the religion, and the evidence is clear that she herself was not too concerned about having a transfusion” .
There were two issues before the Court of Protection under the Mental Capacity Act 2005: did DE have capacity to make the decision in question? and was it in her best interests to have the operation? .
Lieven J concluded that DE lacked capacity in respect of litigation and the decision whether or not to accept blood transfusion if clinically necessary. It appeared from the evidence that although she understood that she needed an operation, she could not understand that one possible consequence might be that she needed a transfusion and that, without it, she would die:
“The evidence clearly suggests that DE cannot retain, use and weigh the information that she is being given about the consequences of refusing a transfusion. This is not an example of somebody making a poor decision, but of not understanding the decision that she is making” .
There was no doubt that it was in DE’s best interests to have the operation. Without it, her long term mobility would probably be impaired and there could be a very serious future risk of pulmonary embolism . It was also in her clinical best interests for the doctors to be able to transfuse her during the operation if need be since, without that option, in an emergency she might die .
As to whether there was a disproportionate interference in DE’s Article 8 rights (respect for private and family life), although she described herself as a Jehovah’s Witness, those beliefs did not appear to be central to her personality or sense of identity; and during the oral hearing, Lieven J had not got “any sense that she would feel deeply upset if an order was made in the form sought, or that she would feel a deep conflict with her religious beliefs”. Further, she had been completely clear that she did not want to die  and her mother supported the operation going ahead . In those circumstances, Lieven J had no hesitation in finding that it was in DE’s best interests to have the operation .
[With thanks to Peter Edge for drawing the case to our attention.]