The Mental Capacity Act and the New Court of Protection the Mental Capacity Act and the New Court of Protection

The Mental Capacity Act and the new Court of Protection The Mental Capacity Act and the new Court of Protection Denzil Lush1 Introduction The Mental Capacity Bill was introduced in the House of Commons on 17 June 2004,2 and received the Royal Assent on 7 April 2005. The Act, which has been fifteen years in gestation and involved an extensive consultation process,3 abolishes the existing Court of Protection, and replaces it with a new court, also to be known as the Court of Protection, which will have jurisdiction to deal with all areas of decision-making for people who lack capacity. Thus, it will combine the personal welfare and healthcare jurisdiction currently exercised by the Family Division with the property and financial decision-making jurisdiction of the present Court of Protection. The new court will be regional, served by a centralised administration office and registry. It is important for people with disputes or problems to have access to the most effective means of resolving them, and in many cases the existing health and social welfare mechanisms, mediation or discussion will be sufficient. Although no one will be compelled to mediate before going to court, the current policy is that the new court should be the last resort for the resolution of complex or particularly sensitive cases, or when other forms of dispute resolution have been tried without success. 1 Master of the Court of Protection. This article is an (1993), Medical Treatment and Research (1993), and amended version of a paper presented at the North Public Law Protection (1993) – before producing its East Mental Health Law Conference in November final report, Law Com. No. 231, Mental Incapacity, 2004. It has been updated at proof-reading stage to on 1 March 1995, which contained a draft Mental reflect the fact that on 7th April 2005 the Mental Incapacity Bill. The Lord Chancellor’s Department Capacity Bill received the Royal Assent. issued a further consultation paper, Who Decides? 2 The Bill was re-published with amendments on 4 followed by its own report, Making Decisions (1999). November 2004, 15 December 2004 and 8 February In June 2003 the Lord Chancellor’s Department (then 2005. recently renamed the Department for Constitutional Affairs) issued a draft Mental Incapacity Bill, which 3 In 1989 the Law Commission embarked on an was subjected to pre-legislative scrutiny by a joint “investigation into the adequacy of legal and other committee of members of the House of Commons and procedures for decision-making on behalf of mentally the House of Lords. The Joint Scrutiny Committee incapacitated adults”. It published four consultation reported on 28 November 2003, papers – An Overview (1991), A New Jurisdiction http://www.publications.parliament.uk/pa/jt/jtdmi.htm 31 Journal of Mental Health Law May 2005 The court’s clientele The Court of Protection is unique. It is the only specialised court of its kind in the world, and is eyed with envy by most other jurisdictions. Its origins go back to at least the second half of the thirteenth century, when the crown assumed responsibility for the estates of lunatics and idiots, and this jurisdiction was certainly in place by 1324, when the Statute de Praerogativa Regis confirmed its continuation. The court’s current clientele fall into four main constituent groups: G people with psychiatric illnesses, such as schizophrenia or bipolar affective disorder. G people with learning difficulties or intellectual disabilities. G the elderly mentally infirm, mainly suffering from Alzheimer’s disease or multi-infarct dementia; and G people who have acquired brain damage as a result of an accident, assault, or clinical negligence, and have been awarded compensation for their personal injuries. It may come as a surprise to note that the present court has comparatively little involvement with the mainstream mentally ill or people with learning difficulties, the two constituent groups for whom it was originally created. Most of the court’s time is spent on matters relating to elderly patients or people with damages awards, principally because these generally tend to be the more complex, higher value cases. The court takes on about 400 new personal injury and clinical negligence cases each year. The average award for a road traffic accident is in the region of £900,000. The average award in a clinical negligence case is about £2,500,000, and the largest award the court is currently handling is £12,000,000.4 I anticipate that the new court, with its jurisdiction embracing healthcare and personal welfare decision-making, as well as decisions on property and financial matters, will involve a re-alignment in terms of meeting the needs of all four groups. Children The original intention was that the legislation would only involve adults who lack capacity, as does the Adults with Incapacity (Scotland) Act 2000. Section 2(5) of the Act still states that no powers under the Act are to be exercised in relation to a person under 16. However, approximately 70% of the clinical negligence cases the present court deals with result from perinatal injuries, and often the patients are under 16. Accordingly, section 18(3) provides that, as far as property and financial affairs are concerned, the powers under the Act may be exercised even though the person concerned has not reached 16, if the court considers it likely that they will still lack capacity to make decisions in respect of such matters when they reach 18. The converse of this is that the Family Division will retain its jurisdiction to make healthcare decisions on behalf of children, as it did recently, for example, in the two cases involving babies, Charlotte Wyatt in Portsmouth, and 4 Parkin v. Bromley Hospitals NHS Trust [2002] EWCA Civ. 478. Kerstin Parkin was born in 1968. She and her husband, Mark, were world-class Latin American dance champions. She suffered profound brain damage following a cardiac arrest whilst in labour at Farnborough Hospital, Orpington, on 26 November 1996. The total compensation awarded was £12,000,000, of which £7,000,000 was received as a lump sum, and the remaining £5,000,000 was used to fund an annuity (known as a “structured settlement”), yielding an index-linked income of £250,000 a year for the rest of her life. 32 The Mental Capacity Act and the new Court of Protection Luke Winston-Jones at Alder Hey.5 Section 21 provides for the transfer of proceedings to the court best suited to deal with the particular issues involved. So, for example, it may be more appropriate for the Court of Protection to deal with a case involving a seventeen-year-old who lacks capacity, since any order under the Children Act 1989 would expire on the child’s eighteenth birthday, at the latest. The principles Before I comment on the expanded role of the new Court of Protection, I think it is important to consider the basis on which the court will make its decisions in future. Any legislation on mental incapacity involves striking a balance between two extremely important values: the value we place on the freedom of individuals to make their own choices about how they live their lives (autonomy or self-determination), and the value we place on promoting their well-being (paternalism or protection). Benjamin Disraeli once said, in the context of the repeal of the Corn Laws, that “protection is not only dead, but damned.” The Mental Capacity Act doesn’t go quite that far, but it certainly gives autonomy and self-determination the upper hand, and almost grudgingly concedes that protection and paternalism have a subordinate role to play, once it is established that a person lacks the capacity to make a particular decision. In this respect the Act endorses the views of the liberal school of philosophy, of which the leading British exponent was Disraeli’s contemporary, John Stuart Mill (1806–1873). In his essay On Liberty, first published in 1859, Mill said:6 “The object of this essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties or the moral coercion of public opinion. That principle is that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number is self-protection. That the only purpose for which power can rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him or visiting him with any evil in case he do otherwise. To justify that, the conduct from which it is desired to deter him must be calculated to produce evil to someone else. The only part of the conduct of anyone for which he is amenable to society is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.” If you read them in sequence, the principles in section 1 of the Mental Capacity Act form a flowchart or blueprint of how in future all of us – parents, carers, doctors, lawyers, social workers, and the court itself – should deal with people who are unable to make decisions for themselves in 5 Charlotte Wyatt (Mr Justice Hedley, 8 October 2004), breakdowns and, although he was never the subject of Luke Winston-Jones (Dame Elizabeth Butler-Sloss, 22 a commission de lunatico inquirendo, he reserved his October 2004).

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