A case of autism, learning disability, and refusal of a planned caesarean

  • Andrew Symon
  • British Journal of Midwifery, March 2017, Mark Allen Group
  • DOI: 10.12968/bjom.2017.25.3.198

What is it about?

This articles describes a court case about the capacity of a 24-year old pregnant woman, who was believed to be autistic, to refuse medical treatment – specifically a caesarean section. The case was complicated because, as a child, she had undergone Female Genital Mutilation (FGM), as well as abdominal scarring to release ‘bad blood’. The Mental Capacity Act 2005 provides the legal framework in England and Wales for deciding whether someone is deemed to be competent to make decisions about their medical treatment.

Why is it important?

It is an extreme stance for a court to rule that someone’s expressed wishes about their own treatment can be over-ridden. However, in some cases this is deemed necessary if they lack ‘capacity’ and it is also shown objectively to be in their ‘best interests’. The woman had had very little antenatal care, having only presented to the maternity services when 30 weeks pregnant. Given the presence of both genital and abdominal scarring, her caregivers had to weigh up the relative benefits and risks of attempting a vaginal birth and having a caesarean section. These complicating factors, added to the woman’s probable autism according to an autism expert (she was assessed as having learning difficulties and an IQ of between 60 and 70) made this a very unusual case.


Dr Andrew Symon
University of Dundee

The restricted timescale available to consider the details of this case was less than ideal, and the maternity service providers were open to criticism for delaying their application to the court. It is reassuring that the courts are unwilling to write a ‘blank cheque’ to clinical practitioners, in the expectation or belief that they will act appropriately.

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