Law Report: Vital surgery on mother ordered: Re S. Family Division (Sir Stephen Brown, President). 12 October 1992

Sir Stephen Brown P granted a declaration that the operation of Caesarian section and necessary consequential treatment which the Bloomsbury and Islington Health Authority proposed to perform on the patient, Mrs S, was in the vital interests of Mrs S and the unborn child she was carrying and could lawfully be performed despite Mrs S's refusal to give her consent.

Huw Lloyd (Bloomsbury and Islington Health Authority solicitor) for the health authority; James Munby QC (Official Solicitor) as amicus curiae.

SIR STEPHEN BROWN P said that the health authority applied for a declaration to authorise the surgeons and staff of the hospital to carry out an emergency Caesarian operation on Mrs S.

Mrs S, who was 30 years-old, was in labour with her third pregnancy. She was admitted to hospital last Saturday with ruptured membranes and in spontaneous labour and had continued in labour. She was already six days overdue beyond the expected date of birth, which was 6 October.

She had refused, on religious grounds, to submit herself to a Caesarian section operation. She was supported by her husband. They were 'born again Christians' and were sincere in their beliefs.

A Fellow of the Royal College of Surgeons, who was in charge of Mrs S, had given a description of the condition of Mrs S.

Her situation was desperately serious, as was also the situation of the unborn child. The child was in a position of 'transverse lie' with the elbow projecting through the cervix and the head being on the right side.

There was the gravest risk of a rupture of the uterus if the section was not carried out and the natural labour process was permitted to continue. The evidence was that it was a 'life and death' situation.

Surgeons and doctors at the hospital had done their best to persuade the mother that the only means of saving her life, and the life of her unborn child, was to carry out a Caesarian section operation.

The surgeon in charge said it was absolutely the case that the baby could not be born alive if a Caesarian operation was not carried out. He had described the medical condition.

His Lordship proposed to make the declaration sought, doing so in the knowledge that the fundamental question appeared to have been left open by Lord Donaldson of Lymington MR in Re T (The Independent, 31 July 1992) and in the knowledge that there was no English authority which was directly in point.

There was, however, some American authority which suggested that if the 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 Re A C (1990) A 2d 1235, 1240, 1246-8, 1252.

His Lordship wholly accepted the evidence as to the desperate nature of the situation and granted the declaration sought.