Court of appeal ordered that Hospital has no lawful power to restrain patient against her wishes

The Court of Appeal has recently ruled that a hospital had no lawful power to restrain a patient in hospital against his or her wishes, notwithstanding that the restraint may have been in the patient’s best interests.

The Court held that hospitals and health care institutions are not entitled to prevent patients from discharging themselves or taking decisions regarding their own care without appropriate lawful authority.  

In AC v CUH [2018] IECA 217, AC had been admitted to hospital following falls which had resulted in multiple hip fractures. The treating team had become increasingly concerned about AC’s welfare and noted that AC was suffering from senile dementia. The hospital also had concerns about how her children were interacting with AC and about how AC’s discharge was to be managed. The hospital was of the view that AC required a high degree of post-discharge care and that she lacked the necessary capacity to make decisions regarding her care. Notwithstanding AC’s express desire to leave hospital, the hospital refused to discharge her.

AC’s son, PC, made two applications under Article 40 of the Constitution seeking inquiries into the lawfulness of the detention of AC by the hospital. The High Court found that AC was detained by the hospital in accordance with law and found that AC lacked the necessary capacity to take decisions in respect of her care. The High Court, in a subsequent sitting, made AC a ward of court. PC appealed the High Court decisions to the Court of Appeal.

The Court of Appeal (Hogan J giving judgment) overturned the judgments of the High Court and declared that AC’s detention by the hospital had been unlawful.

The Court of Appeal held that the hospital had no entitlement at law to prevent AC from leaving the hospital if that is what she wanted to do. The Court noted that there was no statutory power available to hospitals equivalent to s23 of the Mental Health Act 2001, which provides for the restraint of patients in psychiatric hospitals. The Court further held that there is no common law power to prevent a patient from leaving a hospital and, even if such common law power did exist, its constitutional status would be questionable.

In those circumstances, the Court held that her detention by the hospital was unlawful and she was entitled to a declaration to that effect.

This case emphasises an important point, namely that there is no general power to detain a person in a medical institution even if it is in the patient’s best interests. Whilst hospitals and health care institutions are entitled to regulate their own affairs, including limiting access to patients, they are not entitled, without appropriate lawful authority, to prevent patients from discharging themselves or taking decisions regarding their own care. Therefore, unless the patient has been made a ward of court, an enduring power of attorney is in place in respect of the patient or a specific statutory power such as s23 of the Mental Health Act 2001 can be invoked, the patient is and remains the sole decision maker in respect of his or her own care.

A.C. -v- Cork University Hospital & Ors [2018] IECA 217.