Psychosurgery without consent
Since 30 September 1983, when our current Mental Health legislation came into force, it has been illegal for surgeons in England and Wales to perform psychosurgery on people who have not given their consent. But now the government in London wants to change the law and allow surgeons, with court approval, to operate on people who are incapable of consenting. Why do they think there is a need for change?
Under the 1983 Act psychosurgery can only be carried out with the permission of the Mental Health Act Commission (MHAC) who send three people, including a doctor, to verify that the operation is necessary and that the patient’s consent is valid. (Apart from anything else, it means that we at least have accurate statistics on the use of psychosurgery. Between 1984 and 1999 265 operations were carried out in England and Wales.) In about one in five cases the MHAC refuses to give permission for the operation to go ahead, usually because they decide the patient is not capable of consent.
Most operations in the 1980s and early 1990s were carried out at the Brook Hospital in London. (In 1994 the Brook psychosurgery unit moved to the Maudsley/Kings College Hospital) The psychosurgery team at the Brook Hospital was led by psychiatrist Paul Bridges, who was a forceful critic of the legislation from the moment it was introduced, arguing that MHAC involvement interfered with the doctor/patient relationship and that incapable patients should not be denied psychosurgery. In 2001 Bridges was struck off the medical register following a conviction for indecent assault of a 15 and a 16 year old.
The Government is now planning to introduce new mental health legislation and included in their draft bill is the proposal to allow psychosurgery, with court approval, on incapable patients. A recent parliamentary scrutiny committee recommended that the law should remain the same - no psychosurgery without consent - but the government is nevertheless determined to go ahead and change the law. None of the major organisations (with the exception of the MHAC) who gave evidence to the scrutiny committee wanted this change. The Royal College of Psychiatrists, the Mental Health Alliance, the Church of England all, for example, expressly opposed the proposed change in their evidence to the scrutiny committee.
So why is the government so determined to change the law? When I asked them I received this reply from the Department of Health:
“The reason we have gone for the scope to enable people without capacity to have psychosurgery is because the current prohibition has created problems in some rare cases where the patient does not object to the treatment but the treatment cannot be given because the patient is not competent to consent.
For example, the Department was asked for advice on a case concerning a severely learning disabled woman. The care team had tried all other avenues over a long period since she was a child but her condition had worsened and she was in increasing distress. The consultant considered psychosurgery the only way to relieve her distress and bring about an improvement in her condition but, as she was incapable of giving consent, it could not be carried out.”
And who was “the consultant” they were listening to? When I asked the Department of Health, they told me they didn’t know:
“One specific psychosurgery file was destroyed in April 2004, in accordance with the Department's agreed destruction schedules, and it is possible that this may have contained the information you are seeking.”
Until someone can tell me otherwise, I shall believe they have been listening to Bridges (perhaps indirectly via the MHAC), as he seems to be the only psychiatrist who has been campaigning for this change in the law. But should they be listening to a psychiatrist who, in the words of the chairman of the General Medical Council hearing had “brought the profession into disrepute and undermined public trust”?
While the government is planning to make it possible to operate on people who cannot consent, doctors in England appear to have quietly given up psychosurgery. There have been no operations carried out in England since 1999, although a few operations continue to be done in Wales. Scotland also has a centre for psychosurgery but they have their own legislation.
Under the 1983 Act psychosurgery can only be carried out with the permission of the Mental Health Act Commission (MHAC) who send three people, including a doctor, to verify that the operation is necessary and that the patient’s consent is valid. (Apart from anything else, it means that we at least have accurate statistics on the use of psychosurgery. Between 1984 and 1999 265 operations were carried out in England and Wales.) In about one in five cases the MHAC refuses to give permission for the operation to go ahead, usually because they decide the patient is not capable of consent.
Most operations in the 1980s and early 1990s were carried out at the Brook Hospital in London. (In 1994 the Brook psychosurgery unit moved to the Maudsley/Kings College Hospital) The psychosurgery team at the Brook Hospital was led by psychiatrist Paul Bridges, who was a forceful critic of the legislation from the moment it was introduced, arguing that MHAC involvement interfered with the doctor/patient relationship and that incapable patients should not be denied psychosurgery. In 2001 Bridges was struck off the medical register following a conviction for indecent assault of a 15 and a 16 year old.
The Government is now planning to introduce new mental health legislation and included in their draft bill is the proposal to allow psychosurgery, with court approval, on incapable patients. A recent parliamentary scrutiny committee recommended that the law should remain the same - no psychosurgery without consent - but the government is nevertheless determined to go ahead and change the law. None of the major organisations (with the exception of the MHAC) who gave evidence to the scrutiny committee wanted this change. The Royal College of Psychiatrists, the Mental Health Alliance, the Church of England all, for example, expressly opposed the proposed change in their evidence to the scrutiny committee.
So why is the government so determined to change the law? When I asked them I received this reply from the Department of Health:
“The reason we have gone for the scope to enable people without capacity to have psychosurgery is because the current prohibition has created problems in some rare cases where the patient does not object to the treatment but the treatment cannot be given because the patient is not competent to consent.
For example, the Department was asked for advice on a case concerning a severely learning disabled woman. The care team had tried all other avenues over a long period since she was a child but her condition had worsened and she was in increasing distress. The consultant considered psychosurgery the only way to relieve her distress and bring about an improvement in her condition but, as she was incapable of giving consent, it could not be carried out.”
And who was “the consultant” they were listening to? When I asked the Department of Health, they told me they didn’t know:
“One specific psychosurgery file was destroyed in April 2004, in accordance with the Department's agreed destruction schedules, and it is possible that this may have contained the information you are seeking.”
Until someone can tell me otherwise, I shall believe they have been listening to Bridges (perhaps indirectly via the MHAC), as he seems to be the only psychiatrist who has been campaigning for this change in the law. But should they be listening to a psychiatrist who, in the words of the chairman of the General Medical Council hearing had “brought the profession into disrepute and undermined public trust”?
While the government is planning to make it possible to operate on people who cannot consent, doctors in England appear to have quietly given up psychosurgery. There have been no operations carried out in England since 1999, although a few operations continue to be done in Wales. Scotland also has a centre for psychosurgery but they have their own legislation.
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