LH v CC [2020] NZFC 8891

Published 10 May 2021

Application for treatment order — medical intervention — capacity — informed decision — psychosis — Graves' disease — thyroidectomy — objection to surgery — Protection of Personal and Property Rights Act 1988, ss 5, 6, 8 & 10 — R v B (Seclusion) (1993) 11 FRNZ 174 — KR v MR [2004] 2 NZLR 487. The applicant, a consultant psychiatrist, sought an order pursuant to s 10(1)(f) of the Protection of Personal and Property Rights Act ("PPPRA") dispensing with service on the subject person who was an inpatient at a mental health facility. The subject person suffered from schizophrenia and and Graves' disease. The application was in regard to a treatment-resistant psychosis exacerbated by her diagnosis of Graves' disease: one of the possible treatments would require strict adherence to instructions for medicine intake over a period of time, so instead the subject person's clinical team preferred surgery. The subject person objected to surgery on the grounds of religion and risks associated with the surgery. She did not believe she was ill with Graves' disease and believed she had MSG poisoning. The Court had to determine whether the subject person had capacity pursuant to s 6 of the PPPRA to make informed decisions about her own medical treatment and, if not, what order should be made. The medical evidence was that she was incapable of making sound and reasonable decisions due to lack of insight and judgment as a result of her psychosis. In determining what order to make, a court must have regard to the primary objectives of the PPPRA in s 8. The Judge considered the least restrictive outcome to be an order for oral medication, with the buy-in from the subject person, which did not preclude the possibility of an order for surgery after a review. The Judge made an order in relation to the medication to be reviewed in six weeks' time. Judgment date: 16 October 2020. * * * Note: names have been changed to comply with legal requirements. * * *