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Wooder, R (on the application of) v Feggetter & Anor [2002] EWCA Civ 554 (25th April, 2002)
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URL: http://www.bailii.org/ew/cases/EWCA/Civ/2002/554.html
Cite as: [2002] EWCA Civ 554, [2003] QB 219, [2002] 3 WLR 591
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Neutral Citation Number: [2002] EWCA Civ 554
Case No: C/2000/3655 QBCAF
Sir Richard Tucker (sitting as a deputy high court judge)
On the application of JOHN WOODER
DR GRAHAM FEGGETTER
This is an application by the claimant John Wooder for judicial review of a decision of Dr Craig Stewart Feggetter, a Second Opinion Appointed Doctor (“SOAD”) under Part IV of the Mental Health Act 1983 (“the 1983 Act”), to the effect that he should be given medical treatment for a psychiatric condition against his will. The decision in question was made on 25th October 2000. On 30th November 2000 Sir Richard Tucker, sitting as a deputy high court judge, refused permission to apply for judicial review. On 19th March 2001 Henry LJ granted appeal against that decision on one of the points Mr Wooder sought to argue, and also granted him permission to seek additional relief. He directed that the full hearing of the application for judicial review should be reserved to this court.
The nature of the relief now being sought is conveniently set out in the “amended details of remedies sought” which were lodged at this court on 20th February 2002. Mr Wooder now seeks:
i)	A declaration that fairness demands that a SOAD should provide him with written and adequate reasons when certifying under section 58 of the 1983 Act that he should be given medication against his will, and furthermore that this is a general requirement of fairness applicable to all section 58 decisions;
ii)	A declaration that fairness requires that when a section 58 certificate is sought, the patient’s Responsible Medical Officer (“RMO”)’s report to the SOAD must be disclosed to the patient in order that the patient can address its contents when interviewed by the SOAD.
The facts are conveniently set out in a statement of facts lodged with Mr Wooder’s application. He is now aged 52. He moved to the United States with his mother when he was 11 years old. In 1969 he joined the US Army as a driver and was posted to Korea. In 1970 he was attacked by other recruits. In this attack he suffered a head injury and was rendered unconscious. He was honourably discharged from the US Army in 1972. Since his assault he has complained of dizziness, nystagmus, tinnitus, vertigo, hearing loss, balance problems and temporal lobe epilepsy.
In the past he has withdrawn his consent to treatment with anti-psychotic medication due to the side-effects he has experienced. In those circumstances certification for medical treatment without his consent was sought and granted. In October 2000 the renewal of a certificate under section 58 of the 1983 Act was deemed to be necessary, and Dr Feggetter carried out an assessment of him as a SOAD on 25th October 2000. He certified that anti-psychotic medication should be administered to him without his consent. Before the new treatment started on 26th October, there had been a 17-day period, following the expiry of his last certificate, in which Mr Wooder received no treatment. It is maintained on his behalf that there is no evidence to suggest that his condition deteriorated or that he presented a risk of violence to anyone during that period.
On 30th October Mr Kinton (MHAC) wrote a three-page letter in reply. After setting out relevant extracts from the MHAC’s Code of Practice and from its Guidance to SOADs, he went on to quote a passage from a leading text book as to the proper approach to be adopted by a SOAD when the reasonableness of non-consensual treatment is in issue. His letter continued:
“Dr Feggetter has confirmed that he did receive a copy of your letter of the 15 October 2000 prior to his visit and that he carefully considered its content before reaching his decision. I understand that Dr Feggetter also spoke with you on the day of his visit. You will be aware that Dr Feggetter met with your client and that your client was able to state his views on the treatment that he has received in the past and on the treatment proposed by his RMO. Dr Feggetter also consulted with the RMO and the statutory consultees. The RMO presented Dr Feggetter with a 25-page document as a background to her decision to seek authority to treat your client.
If you wish to discuss this matter further I am happy to do so.”
On 3rd November Mr Kinton elaborated a little, following a further letter from the claimant’s solicitors. He identified the 25-page document which had been provided to Dr Feggetter, and said that the solicitors should approach the RMO if they required access to it. He corrected one matter in his earlier letter. He now said that Dr Feggetter did not certify that Mr Wooder was incapable of giving consent to his treatment. Dr Feggetter’s view was that although Mr Wooder lacked insight into his illness, he was able to give valid consent to treatment but refused to do so.
Mr Kinton said that the RMO must remain the primary point of information and discussion with the patient about the treatment plan which the SOAD had authorised as reasonable. He rejected the solicitors’ contention that someone other than the RMO should explain the rationale for treatment to a patient who has received a statutory second opinion.
On 30th November 2000 Sir Richard Tucker refused permission to apply for judicial review. He was at that time concerned, so far as is relevant to this appeal, only with the first of the declarations mentioned in paragraph 2 above. He said that it was common ground that neither the 1983 Act nor the Code of Practice contained any obligation to give reasons. He did not consider it appropriate to describe a SOAD’s role as quasi-judicial. He was a doctor whose task it was to certify whether or not a particular course of treatment was appropriate. A SOAD was acting under a statutory regime and had to comply with his statutory obligations, which did not contain a duty to give reasons. Either a course of treatment was suitable or it was not. He said that the regime suggested by the doctor was, whether Mr Wooder thought so or not, one which was in his best interests and in the best interests of society at large.
We were shown in this context paragraphs 6.14-6.30 of the Review of the Mental Health Act 1959 (1978 Cmnd 7320) which preceded the introduction of the new legislation. In paragraph 6.14 of this White Paper a reference was made to contemporary uncertainties about the legality of treating detained patients without their consent. It was said that the Government wished to remove any uncertainty. It proposed to amend the Mental Health Act to define the extent to which treatment for mental disorder could be imposed.
“… [It] is well established that when a statute has conferred on any body the power to make decisions affecting individuals, the courts will not only require the procedure prescribed by he statute to be followed, but will readily imply so much and no more to be introduced by way of additional procedural safeguards as will ensure the attainment of fairness.”
I can see no good reason why the same discipline should not apply to the decisions of SOADs. Indeed, we were shown during the course of argument the short two-page letter written by Dr Feggetter to Mr Kinton (MHAC) on 26th October 2000 which would have served admirably as the requisite statement of reasons, when coupled with the formal certificate he had signed the previous day. It is very clear that Dr Feggetter did not feel that Mr Wooder had sufficient knowledge of his illness and its potential for violence to be a reliable witness on his own account as to the absence of any risk of further violence if he remained untreated. Dr Feggetter stated concisely and clearly the reasons why he agreed with the RMO’s view that she should be able to treat him. He was clearly influenced by the need to protect other patients and staff on the ward from the risk of an assault by Mr Wooder (which Dr Feggetter described as “his dangerousness”) if he were to remain unmedicated. It is understandable why he thought, although he did not spell this out, that other considerations should take second place.
The next issue we have to decide arises mainly out of the terms of the second declaration which Henry LJ granted Mr Wooder permission to seek judicial review (see paragraph 2(ii) above). It seems inappropriate for us to express any opinion on this point. Although the RMO’s solicitors were served with notice of the amended application, Dr Heads has not appeared at the hearing or made representations to the court on the issue. In these circumstances we do not know the contents of the 25 pages which Dr Heads gave Dr Feggetter, and we were told that no point of general principle arises here. Ms Lieven told us that an RMO will very often prepare no special report for a SOAD but merely invite him to consider the medical records already in existence, adding perhaps a few words of explanation. She suggested, without knowing the detail, that it was quite likely that the papers Dr Heads gave Dr Feggetter were records with which Mr Wooder was familiar in any event.
Finally, I would reject Mr Fitzgerald’s submission that a patient should be given the SOAD’s reasons by someone other than the RMO. The RMO is the doctor responsible for the patient’s care and it may be that matters will be known to the RMO, but not to the SOAD, which make it one of the exceptional cases for withholding disclosure on “serious harm” grounds. In future, therefore, the SOAD should send a statement of his reasons to the RMO or to the hospital (see section 132 for the duty of the hospital managers to give relevant information to a detained patient) together with any opinion he may have on the desirability of withholding them from the patient on “serious harm” grounds. The RMO should then make them available to the patient to read, unless it is a case in which reliance can properly be placed on the “serious harm” exemption from disclosure.
The reasons should be prepared and disclosed to the patient as soon as practicable. Mr Fitzgerald did not pursue to the end his argument that this process must necessarily always precede the administration of the sanctioned treatment. It is only necessary to consider the facts of a case like Wilkinson (see [2001] EWCA Civ 1454 at [4]; [2002] 1 WLR 419) to understand that it may not always be appropriate to delay treatment once the SOAD’s certificate has been given.
By way of a footnote it is pleasant to be able to record that Mr Wooder’s medication has now been reduced to the lowest dose of anti-psychotic medication possible, coupled with a daily mood stabiliser. He is settled on this medication regime, for which he has signed the requisite form, and is progressing well. This does not, however, mean that the point we are deciding is necessarily an academic one even in his case, since he continues to be a detained patient and the occasion may arise in the future when he refuses to consent to a proposed treatment. (Compare Wilkinson at [7]).
Mr Fitzgerald’s argument in its strong form does not depend on any expansion of the duty to give reasons beyond the point reached a decade ago in Doody. Here, as there, it can be said that the impact of the decision is so invasive of physical integrity and moral dignity that it calls without more for disclosure of the reasons for it in a form and at a time which allow the individual to understand and respond to them. But even if Ms Lieven is right in her submission that there is a material difference between an administrative decision relating to incarceration and a medical opinion relating to treatment, the answer does not necessarily differ.
But if this is wrong, or if for some other reason the analogy with life-sentence prisoners’ tariffs is imperfect, it becomes necessary to look more closely at the present ambit of the duty to give reasons. No advocate should today embark on an argument about this without considering, in addition to the reported cases, the article by Professor Paul Craig [1994] C.L.J 282 on the Higher Education Funding Council case, and the chapter by Sir Patrick Neill QC (as he then was) in The Golden Metwand and the Crooked Cord (OUP, 1998, p.161), ‘The duty to give reasons: the openness of decision-making’. They demonstrate the distance still to be travelled in this regard between the present state of English authority and a principled framework of public decision-making.
“….we did not hold … that the categories of case in which reasons must be given were closed. In our concluding summary we went no further than to hold that the class of apparently aberrant decisions did not include those which were challengeable by reference only to the reasons for them, such as a pure exercise of academic judgment.
I consider it arguable … both that the categories derived from authority in [the HEFC case] are incomplete, and that that even within them there may be exercises of academic judgment which, though never patently aberrant, are nevertheless of sufficient importance to the individual to require that reasons be given for them.”
If therefore Ms Lieven were right in urging that the SOAD’s opinion is analogous to an academic judgment in being challengeable only by reference to the reasons for it and so beyond the reach of the duty to give reasons (a syllogism which, though it was understandably welcomed at the time in academic circles, I have come to suspect may be flawed), it would be necessary to ask whether the HEFC case would necessarily be decided in the same way today. For my part I am not sure that it would be, although it would certainly not follow that every examination grade and mark had to be similarly explained. It is certainly not an answer, with all respect to Ms Lieven’s argument, that the cases relied on by Mr Fitzgerald concern adjudication and are therefore distinguishable. To collapse substance into form in this way would be to invert the logic of modern public law and to turn it back towards the arid categories of judicial, quasi-judicial, administrative and discretionary acts which dogged it in its postwar resurgence.
It is particularly necessary to bear two things in mind when reading the HEFC decision. One is that Lord Mustill had been careful, shortly before, in Doody to say that “the law does not at present [my italics] recognise a general duty to give reasons for an administrative decision”, while the court in the HEFC case rejected the submission that particular duties to give reasons could any longer be regarded as exceptional. Sir Patrick Neill’s article (above) shows amply why this is so. Secondly, as again Sir Patrick points out, lawyers seem to have manifested their classic learnt response to those two cases by treating the categories so far acknowledged in the reactive and exploratory growth of the common law as exhaustive. Rather than try to fit given shapes into pre-formed slots like toddlers in a playgroup (I am not referring to the educated and thoughtful arguments before us), the courts have to continue the process of working out and refining, case by case, the relevant principles of fairness.
One relevant divergence is that the common law sets high standards of due process in non-judicial settings to which the Strasbourg court declines to apply art. 6. Here a claimant can derive better protection from the common law than from the Convention, and s.11(a) of the Human Rights Act expressly preserves his right to do so. It is why I consider that the difficult argument about the point at which art. 6 bites on the s.58 process is of only secondary relevance. For reasons I have given, Mr Wooder can derive all the protection he is entitled to from the duty to give reasons at common law.
The Human Rights Act itself contains a warrant for both processes. The s.6 prohibition on acting incompatibly with Convention rights arguably conditions the common law itself: see now A v B [2002] EWCA Civ 337 para 4. It is probable, though as yet undecided, that “acting” governs remedies and procedures rather than doctrines of substantive law; but judicial review is very largely about remedies, the giving of reasons among them. The s.3 imperative, by contrast, is directed purely to the process of statutory construction. It is not, in my belief, anything like as revolutionary as strict constructionists have suggested. Once it is acknowledged that parliamentary intent has always been a deferential but fictional account of the meaning of the text (which is why Pepper v Hart [1993] 1 AC 593 was and still is so heavily contested), s.3 ceases to be a supplanting mechanism and settles in as a strong canon of construction. As such it clearly operates in the present case on s.132 of the Mental Health Act 1983, elaborating the requirement to inform the patient “so far as relevant in his case” about the effect of s.58 so as make the obligation fully Convention-compliant. Even if s.132 were not there, exactly the same result would in my opinion be arrived at through s.58 itself, because what matters for s.3 purposes is not the particular configuration of the statute but whether (a) its subject matter attracts Convention rights and, if it does, (b) its terms nevertheless block their application.
Given the present divergences between the common law and the Convention, I think care is required, for reasons which this appeal illustrates, in mapping the route by which their respective standards and controls are to be imported into public law functions. In a generation’s time, when the Convention rights have become second nature to lawyers (as the innovative principles of modern criminal law became second nature to them in the course of the nineteenth century) the difference between the two methods of rapprochement will probably cease to matter. For the present, for the reasons given by Lord Justice Brooke, I agree that both the common law path, by way of incremental development, and the Convention path, by way of art. 8, take Mr Fitzgerald home on his principal argument that the patient is entitled, not as a matter of grace or of practice but as a matter of right, to know in useful form and at a relevant time what the SOAD’s reasons are for his opinion on the RMO’s proposal to override his will.
I agree with the judgment of Lord Justice Brooke and the observations of Lord Justice Sedley on the duty to give reasons. I too consider that Mr Wooder can derive the protection to which he is entitled from the duty to give reasons under common law, subject to an exemption framed in the terms indicated in paragraph 30 of the judgment of Lord Justice Brooke. I have also read with interest the observations of Lord Justice Sedley under the heading ‘The Vehicle of Change’. In that connection I would observe that in my opinion it is not necessary to resort to any consideration of the extent to which Article 8 of the Convention may be engaged for the purposes of a decision in this case.
Order: Appeal allowed with costs here and below to be subject to detailed assessment by a costs judge. Declaration as agreed with counsel in terms stated in paragraph 31 of judgment. (Order does not form part of the approved judgment)