It would seem that it is never lawful for a doctor to force a competent person to have treatment against her wishes. If a Jehovah’s Witness refuses a blood transfusion, knowing that she will most likely die, that wish will be respected.2 If a terminally ill patient refuses treatment which would prolong her life, that wish will be respected. A person who could save the life of another by donating bone marrow cannot be forced to do so, even if it is necessary to save the life of her own child. A competent patient can refuse treatment irrespective of whether it jeopardises her own or another’s life. The vast majority of legal commentators not only agree with the law’s protection of patient autonomy, but would also extend this liberty to a pregnant woman in respect of treatment which would save the life of her foetus.3 But courts have not always been so sure. Beginning with Re S in 1992,4 judges have, on a number of occasions, acceded to doctors’ requests to declare lawful decisions to carry out Caesarean sections on women who have refused consent. These decisions have attracted almost universal dissent in the legal and medical press,5 and the Court of Appeal stemmed this tide in March 1997, pronouncing in Re MB that a woman cannot be compelled to undergo a Caesarean against her will if she is competent to take that decision, even if the likely result is her own death or that of her baby.6 This may prove a victory of
Pyrrhic proportion, since incompetence has been established in all cases since Re S,7 including in Re MB itself.