ABSTRACT
The patient, Mr SJ, was 43 years old, diabetic, incontinent of urine and stool and detained under the Mental Health Act 1983 due to psychosis. The Official Solicitor represented SJ in court. It was accepted that the patient lacked capacity because he was unable to understand or believe information given to him, and unable to weigh the advantages against the disadvantages of colostomy formation. The court was told that SJ did not want the operation because he believed it would cause him further pain. The court found that SJ's fears of postoperative pain were unfounded, and that he would both tolerate the colostomy, and be much happier as a result of it. This is an instance where a patient's wishes were at odds with what manifestly accorded with his welfare. A much more difficult decision would have loomed if the patient's coherent wishes and accurate beliefs betrayed, in reality, his capacity.
