Court approves sterilisation of disabled father

The Court of Protection has sanctioned the sterilisation of a man with learning difficulties in order to restore his “hard-won independence” and allow him to resume his “enduring and loving” relationship with his long-standing girlfriend, who also suffers from learning disabilities.

In the ruling – the first in England to sanction a man’s sterilisation – a judge said a vasectomy would be “lawful and in the best interests” of DE, who lives in the Midlands and lacks capacity to make the decision for himself.

High Court judge Mrs Justice Eleanor King said DE’s 10-year “remarkable and precious” relationship with his girlfriend had nearly broken under the strain of the couple being kept apart to avoid an unwanted second pregnancy following the birth of a child – “but remarkably it has weathered the storm”.

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She ruled the overall picture pointed to “re-establishing as normal a life as possible as soon as possible for DE”, now nearly 37.

The judge said the birth of the child in 2010 had a “profound” effect on the families of the couple and led to a ban on the couple being left alone together.

Another pregnancy would undoubtedly cause “further and probably more serious psychological distress and consequences for DE”.

The judge said DE had an amenable personality and “prospered and achieved far beyond what may have been expected given his level of disability” but had suffered badly and had his confidence shaken by the loss of his independence.

His case had come to court because his learning problems meant he lacked capacity to consent to a vasectomy.

The judge said DE’s social worker, who specialised in looking after disabled adults, had told the court “how very unusual it is to see such an enduring relationship between two significantly disabled people”, adding it was “remarkable and very precious and should be valued and protected in their interests”.

The girlfriend’s learning disabilities were not as severe as his, but she was unable to look after her baby by herself. She lived with her own mother, who had been declared the baby’s special guardian, and was accompanied by a support worker when she took the child out.

DE’s parents undoubtedly had some reservations about the relationship. The judge said: “Reading between the lines I suspect that they felt that PQ [the girlfriend] was drawing DE into a relationship the nature of which he could not fully understand.”

DE suffered considerable distress as his life was “turned upside down” to ensure the couple were not alone together, and visits to each other’s homes were stopped.

He struggled to understand what was going on and denied the baby was his – “at that time he did not seem to comprehend that anything that he and PQ had done together had resulted in the birth of a child”.

But he had been seen to play with his son and call him “my child, my child”, while making it clear he did not want another.

For three to four months PQ ended their relationship “to his considerable distress” following a ruling that he did not have the capacity to consent to sexual relations. PQ was frightened she might lose her baby if she stayed with him.

The relationship resumed in March this year, and by July parents and experts agreed that DE could consent to sexual relations, but could not consent to contraception.

The judge said a vasectomy was “undoubtedly in DE’s best interests”.

One medical expert had regarded the “most magnetic factor” in favour of a vasectomy as his desire not to have any more children.

But the judge said “allowing DE to resume his long-term relationship with PQ and restoring to him his lost skills and independence are as important, if not more so, when determining his best interests”.

The judge said that, when assessing the case under the provisions of the 2005 Mental Capacity Act, she had kept to the forefront of her mind the consequences of a vasectomy were – ignoring the possibility of a reversal – to render him permanently infertile.

The application to allow a vasectomy was made by DE’s local NHS Trust with support from his parents, his GP and the local authority involved in his care.

The judge said she would make the appropriate orders and declarations that it was lawful and in DE’s best interests for surgeons to take any reasonable and proportionate steps to perform a vasectomy, including sedation, local and general anaesthetic.

The judge ordered the operation to be carried out by a consultant urological surgeon and the necessary sedation administered by a consultant anaesthetist.

The Official Solicitor has confirmed the case marks the first time a court in England and Wales “has made orders permitting the sterilisation for non-therapeutic reasons of a male unable to consent to such a procedure”.

The charity Mencap welcomed “the emphasis placed on the fact that this is an exceptional case and should not be seen as a green light for other applications for sterilisation in respect of people with a learning disability”.