ABSTRACT
Choice is a central tenet of maternity care, but whilst policy documents emphasise patient choice, not all childbirth options are available to all women, nor will all options be considered valid, or even responsible options. This is particularly the case when a woman has a serious mental illness (SMI). Her choices are easily dismissed, attributed to her mental illness, or a more general lack of insight, extending beyond her SMI into her pregnant state. This chapter focuses upon the role of insight (a clinical term of art) in determining capacity and the degree of respect afforded to the woman’s delivery choices within the assessment of her best interests. It interrogates the relationship between insight and capacity through the lens of two recent cases (The NHS Acute Trust & The NHS Mental Health Trust v C and A University Hospital NHS Trust v CA), recognising that in both cases the perceived lack of insight was fatal to the women’s capacity and suggesting that in the context of women with an SMI, or a learning difficulty the notion of patient-centred, choice-led maternity care is illusionary.
