By Victor Storm
A young Englishwoman was allowed to commit suicide in hospital over four days. Kerrie Wooltorton had a history of mental illness and had made multiple attempts on her life. Yet it was deemed she had the mental capacity to refuse treatment.
That refusal was legally binding on hospital doctors under the provisions of the British Mental Capacity Act.
There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.Credit: Angela Wylie
The coroner, William Armstrong, found that the doctors involved with her care had acted lawfully by not trying to save her life. Otherwise they may have faced sanction under the Medical Practice Act, been liable to deregistration and charged with assault.
''She had capacity to consent to treatment which, it is more likely than not, would have prevented her death,'' Armstrong said. ''She refused such treatment in full knowledge of the consequences and died as a result.''
Wooltorton was 26.
It is an invidious situation for health professionals to find themselves in. The matters surrounding Wooltorton's death and the coronial inquiry are disturbing. The death by self-poisoning of a disturbed and depressed young woman was sanctioned - a situation that I hope is never repeated.
Medical practice laws in Britain and NSW have many similarities, but we are fortunate that under current legislation in this state a similar situation would not receive legal sanction.
Mental capacity assessments here do not include a legal right to commit suicide in the way Wooltorton chose. If such a clinical situation were to arise in a NSW hospital, the Mental Health Act should usually be invoked and resuscitative treatment given.
Is this a draconian denial of an individual's rights? I think not. There are important reasons for us to reject the legalistic argument used in Britain.
I am a psychiatrist who has worked in mental health for 30 years. I have treated people with complex disorders who have made multiple attempts at suicide, recovered and been grateful for the ongoing care that allowed them another chance to lead a satisfying life. This experience is common for most clinicians.
To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death.
We are faced regularly with individuals who suffer significant depression and despair for extended periods. People may express a wish to die, and some might make multiple attempts on their lives, but most clinicians will try as hard and as long as they can to help ease a person's suffering and bring on recovery.
In most instances, clinical intervention is successful. Most people who seek the support of our services recover and get on with their lives. It is important for the wider community to understand that even those who suffer serious depression associated with other mental health problems generally get better, even if it takes some years.
Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.
Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.
Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable.
Families and friends suffer enormously when people commit suicide - and society as a whole is diminished. There is a place for compulsory treatment. There is a need for persistent attempts to involve depressed and disturbed individuals in some form of ongoing psychological and psychiatric care. Temporary deprivation of liberty under a mental health act may be required.
There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.
Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat - even if our treatment is sometimes controversial.
Even if Wooltorton had no current sense of hope, there would have been good grounds for us to work towards her recovery.
Her suicide is quite different from people who decide to cease active treatment when their lives are ending due to general debility or failure of bodily systems and there is no feasible possibility of recovery.
Her death leaves a nagging doubt: that in spite of what she said verbally and in writing, she took measures of self-harm that were not immediately fatal. She asked to be in hospital, where she could have received treatment and another chance at life.
Perhaps her non-verbal cues were missed. Her father has expressed a wish that the mental capacity law be changed. I support his wish. I am grateful no such law exists in NSW.
Associate Professor Victor Storm is clinical director of mental health at the Sydney South West Area Health Service.For help, call Lifeline on 13 11 14.