Refusing medical treatment after attempted suicide: Rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case Sascha Callaghan and Christopher James Ryan * The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient’s wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to override the patient’s choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient’s competence to make their own choice. However, the test for legal competence must take into account the person’s agency in making the decision, and decisions which will effectively end the person’s life must be shown to be thought through. INTRODUCTION On 17 September 2007, a 26-year-old woman named Kerrie Wooltorton consumed several glasses of antifreeze in a suicide attempt and called an ambulance. She carried a letter informing doctors that she knew the consequences of her actions, wanted no life-saving treatment, and had come to hospital only so that she could be made comfortable and because she did not want to die alone. The letter is set out in full below. To whom this may concern, if I come into hospital regarding taking an overdose or any attempt of my life, I would like for NO lifesaving treatment to be given. I would appreciate if you could continue to give medicines to help relieve my discomfort, painkillers, oxygen etc. I would hope these wishes will be carried out without loads of questioning. Please be assured that I am 100% aware of the consequences of this and the probable outcome of drinking anti-freeze, eg death in 95-99% of cases and if I survive then kidney failure, I understand and accept them and will take 100% responsibility for this decision. I am aware that you may think that because I call the ambulance I therefore want treatment. THIS IS NOT THE CASE! I do however want to be comfortable as nobody want to die alone and scared and without going into details there are loads of reasons I do not want to die at home which I realise that you will not understand and I apologise for this. Please understand that I definitely don’t want any form of Ventilation, resuscitation or dialysis, these are my wishes, please respect and carry them out. When questioned by doctors following her admission, Kerrie said simply: “It’s in the letter, it says what I want.” The treating doctors consulted widely and sought legal advice. They took the view that Kerrie was competent to refuse treatment and, on this basis, believed they were obliged to act in accordance * Sascha Callaghan, BEc (Soc Sci), LLB (Hons), M Bioethics, Doctoral Scholar, Centre for Values, Ethics and the Law in Medicine, University of Sydney; Christopher James Ryan, MBBS, FRANZCP, Consultation-Liaison Psychiatrist, Westmead Hospital, Westmead, New South Wales, and Senior Clinical Lecturer, Discipline of Psychiatry and the Centre for Values, Ethics and the Law in Medicine, University of Sydney. Correspondence to: sascha.callaghan@sydney.edu.au. (2011) 18 JLM 811 811 © 2011 Thomson Reuters (Professional) Australia Limited for further information visit www.thomsonreuters.com.au or send an email to LTA.service@thomsonreuters.com Please note that this article is being provided for research purposes and is not to be reproduced in any way. If you refer to the article, please ensure you acknowl- edge both the publication and publisher appropriately. The citation for the journal is available in the footline of each page. Should you wish to reproduce this article, either in part or in its entirety, in any medium, please ensure you seek permission from our permissions officer. Please email any queries to LTA.permissions@thomsonreuters.com