Woman 'should have vital surgery'
A mentally-ill woman should undergo heart surgery against her will, a judge has ruled.
Judge Isabel Parry was told that the 34-year-old woman had a "life-threatening cardiac condition" but was "firm and clear" that she did not want surgery.
The judge has ruled that surgery would be "lawful" and in the woman's "best interests" following a hearing in the Court of Protection - where issues relating to sick and vulnerable people are analysed - in Cardiff.
She also said it would be lawful for medics to administer "such physical and/or chemical restraint" as may be required to deliver treatment.
Judge Parry said the woman could not be identified.
The judge said health authority officials had asked her to rule that surgery could go ahead - but she did not name the authority involved.
Detail of the case has emerged in a written ruling published by the judge.
Judge Parry said she had analysed evidence at a public hearing in early April.
The woman was an inpatient in a "low secure" private hospital, said the judge.
She had autism and a schizophrenic illness.
Judge Parry concluded that the woman did not have the mental capacity to make decisions about the proposed surgery.
"The medical need for surgery is clearly made out as the risk of death from the untreated cardiac condition is significant and increasing and can only be properly addressed by elective surgery rather than a 'wait and see' approach," said Judge Parry.
"Further the process of managing (the woman) in the post-operative period will give rise to issues of restraint that may be both physical and chemical."
But she added: "Whatever be the strength of the medical evidence, (the woman) is firm and clear that she does not want surgery. Attempts have been made by her treating clinicians and the clinical team around her to explain the benefits of surgery.
"(She) has understandable fears around the procedure such as not waking up... Equally (she) does not want to die but she would rather see what happens without surgery."
The judge said she had balanced the "risks and benefits".
And she said she recognised that "imposing" unwanted surgery was a "very serious step" only to be taken where "necessary".
But the judge added: " This is not a case in which the proposed course of medical treatment is merely desirable or would make (the woman's) day-to-day life easier. She is at risk of dying if she does not undergo this particular cardiac surgery."
Judge Parry said the woman had an aneurysm which could rupture.
And she said the choice she had to make was "stark".
"The medical evidence is uncontroversial and powerful," said the judge.
"The only treatment for this heart defect is surgery. Without surgery there is an increasing likelihood of rupture and almost instantaneous death."
Judge Parry added: "There are mortality risks in surgery but they are far less than the risk of (the woman) dying as a result of a rupture of the aneurysm."
The judge said specialists also felt that it would be necessary to remove the woman's lower teeth prior to heart surgery.
And she ruled that "necessary pre-operation dental extractions" should also go-ahead.