The courts are often called upon to sanction treatment for patients whose ability to make decisions for themselves is impaired. In a recent case on point, the Court of Protection had to decide whether it was in the best interests of a man with mental health issues to have his right leg amputated above the knee.

The man, aged 60, was taken to hospital by his niece. He was found to have an ulcerated leg. He had a history of paranoid schizophrenia, and believed that the sores on his leg were caused by Wi-Fi and lasers. At different times he had said that there was nothing wrong with his leg, that it was burned rather than anything more serious, and that he had not ruled out surgery but wanted more time to consider it. Medical staff were of the view that an above-knee amputation was necessary as soon as possible in order to prevent the infection spreading and save his life.

The Court first had to consider whether the man had the capacity under the Mental Capacity Act 2005 to make decisions about his care. It found that he was unable to understand his condition and the risks associated with it, and could not repeat information just given to him about his condition and treatment. As such, he lacked the capacity to make a reasoned decision.

The Court then had to decide what treatment was in the man's best interests. Medical opinion was that an above-knee amputation was the only realistic option. He was expected to recover well from the operation, whereas he would be likely to suffer life-threatening sepsis if it did not go ahead. The man's family supported the proposed amputation and he himself had expressed a wish to live. Although the operation would carry risks and might have a negative impact on his mental health, it was clearly in his best interests.