not to continue with it. This is a difficult issue which may need to be considered
in depth on another occasion.' [41]One of the most important aspects of the decision inRe MBis that it provides
guidance for future cases in this area by setting out procedures which should be
undertaken. This includes the requirement that the woman should be represented
in all cases save where ,in exceptional circumstances ,she does not wish to be so
[42]. This recommendation goes some way to meet concerns as to the manner in
which such proceedings have been brought [43]. This guidance has been
subsequently incorporated into an NHS circular [44] ,and considered further inSt
George's NHS Trustv.Sdiscussed below.
7.2.6 Caesarean sections and the Mental Health Act
There have also been a number of cases in which the Mental Health Act 1983 was
used to sanction the performance of caesarean sections upon mentally incompe-
tent women. Section 63 of the Act provides that:
`The consent of a patient shall not be required for any medical treatment given to
him for the mental disorder from which he is suffering.'The boundaries of section 63 ± what amounted to medical treatment for mental
disorder ± came before the courts inTameside and Glossop Acute Hospital Trustv.
CH?1996) [45]. CH was detained under section 3 of the Mental Health Act 1983.
She was suffering from paranoid schizophrenia. She was then discovered to be
pregnant. It was held that as she lacked capacity to consent or refuse treatment a
caesarean section could be authorised as the performance of a caesarean section
was treatment for mental disorder' and thus fell within the scope of section 63 of the Mental Health Act 1983. This was because if a stillbirth had occurred her health would have deteriorated and she needed strong anti-psychotic medication which could not be given to her when she was pregnant. The court followed the approach inBv.Croydon HA?1994) ,that section 63 of the 1983 Act encompassed matters which related to thecore treatment' ?in that case including force feeding).
Such a broad interpretation of this provision has been criticised [46]. For example,
as Grubb has argued ,section 63 does not cover any physical condition which
impedes treatment of mental disorder. As he notes:
`The Government saw section 63 in far more limited terms covering perfectly
routine ,sensible treatment' [47].Acontrasting approach was taken by the Court of Appeal in the case ofSt George's
NHS Trustv.S?1998). S was diagnosed as suffering from severe pre-eclampsia. She
was advised that she should have an early delivery. S ,who had intended a home
delivery ,refused treatment. She asserted that nature should take its course
although she was informed as to the risk of death and disability to herself and the
fetus. Her GP initiated steps which led to her detention in hospital under section 2
of the Mental Health Act 1983. She was subsequently transferred to another
hospital. While she persistently refused treatment and sought legal advice ,the
hospital authority ,without her knowledge ,made anex parteapplication to the
Consent and the Capable Adult Patient 109