KP (Termination of Pregnancy), Re

KP is an intelligent 19 year old woman who has experienced very many challenges in her life and who is now 17 weeks pregnant. The Court is called upon to decide whether she has mental capacity (i) to decide whether to terminate or continue the pregnancy, and (ii) to consent to a contraceptive implant being inserted under her skin. If she lacks capacity to make those decisions, or either of them, then the court must make the decisions for her in her best interests. None of the professionals involved in KP’s care have found it easy to determine whether KP has capacity and, if not, what is in her best interests.

At the hearing I received oral evidence from Dr A, Consultant Gynaecologist, and Ms B, manager of the organisation providing accommodation, care and support for KP. The Court’s determinations were urgently required because, firstly, the risk of complications from a termination of pregnancy would significantly increase from 19 weeks of gestation, and, secondly, delays in making the decisions were causing harm to KP’s mental health and thereby creating risks to her and the baby. Accordingly, I announced my determination at the hearing, promising to give my reasons in this written judgment.

Two matters need to be addressed at the outset of this judgment:

KP suffered hypoxia at her birth in 2006 leading to an acquired brain injury. She has been diagnosed as having cerebral palsy. She was adopted as a child but in 2019 the adoption broke down and she was taken into the care of the local authority. She then had a series of 22 placements, presenting as dysregulated with challenging behaviours including self-harm by cutting, ligatures and overdoses. In 2024 a psychiatrist concluded that she had traits of Borderline Personality Disorder. Later that year she was diagnosed with Autism Spectrum Disorder. KP has not been diagnosed with Dissociative Identity Disorder (previously known as Multiple Personality Disorder) but she is known to have adopted a number of different personas. These personas or identities inhabit her. They have names and she lives as them for varying lengths of time. In 2024, her persona was that of a three year old girl. She stopped eating, drank from a baby’s bottle, and required a pacifier to calm her. Currently she has the persona of a 13 year old girl, as explained below.

Some 15 months ago P was placed with the organisation of which Ms B is manager and director. The organisation provides a therapeutic approach to KP’s care which has been effective. KP made progress. She is able to live in a supported living placement receiving consistent care around the clock. KP has been the subject of ongoing Court of Protection proceedings concerning her residence, care, and contact with others. The application before me has been made separately but, pursuant to my directions, I have had sight of documents from those welfare proceedings including capacity assessments performed by an independent expert psychiatrist, Dr Rippon.

Having previously advised that KP lacked capacity to make decisions about her residence, care and contact, in her third report Dr Rippon assessed KP as having capacity to make decisions about contact with others. Ms B advised me that this was at a time when KP was particularly well. She has known KP to enjoy two such periods in her time under her organisation’s care. It was determined in or around April 2025 that it should be presumed that KP had capacity to engage in sexual relations. KP had met a man, CD, online and he then visited her in person. They formed a relationship and began to engage in sexual relations. KP assured staff caring for her that she was not engaging in vaginal intercourse and so did not need contraception, but in fact she and CD did so and KP became pregnant.

KP underwent a positive pregnancy test on 22 July 2025 and a privately funded ultrasound scan on 24 July which revealed that she was 7 weeks’ pregnant. A social worker was appointed for the unborn baby. KP was initially excited about her pregnancy. She made plans and purchased baby clothes. She was supported by CD who was also positive about the prospect of having a child. KP asked whether she could care for the baby at her current placement. Ms B began to make enquiries about varying her organisation’s registration to enable that to happen. Ms B told me that it was thought by her and the social worker to be feasible that, with support, KP might be able to care for her newborn baby.

Then, in early August 2025, KP experienced light vaginal bleeding (spotting) and became convinced that she had miscarried. She funded a further scan which showed a foetal heartbeat but KP struggled to accept that it belonged to the baby. She does now accept that she is carrying a live baby but she is clear that she wishes to have a termination of the pregnancy. She first asked for a termination on 8 August 2025.

The experience of spotting and belief that she had miscarried appears to have triggered a significant deterioration in KP’s mental health as well as a change in her stated wishes and feelings about continuing the pregnancy. Following the spotting and belief that she had miscarried, KP’s persona became that of a 13 year old girl. She remains in that persona. KP has said that “a child cannot have a child” as a reason why she cannot continue the pregnancy. She believes that her child will be removed from her and taken into the care system which, given her own experiences in care, causes her great distress. She very much wants to avoid that happening. She has claimed to have tried to terminate the pregnancy herself by insertion of a coat hanger. This was not witnessed but blood was seen on her bedsheets. She says that her internet research has taught her that she could bring about a termination by taking a large quantity of a certain kind of over-the-counter medication. She has cut her abdomen. Incidents of self-harm and staff interventions have markedly escalated. She has expressed deep frustration that her wish to have a termination is not being followed.

Although it was rapid, KP’s deterioration was not immediate. For a short while she appears to have had some insight that she was deteriorating and asked Ms B to stick by her and not to allow her to make unwise decisions. She reported that she had miscarried, without others knowing, when she was only 12 after being sexually abused. I should note that the Family Court has previously found allegations made by KP in relation to sexual and other abuse not to be proved. However, this recalled experience seems to have contributed to her deterioration and the adoption of the 13 year old persona.

Sadly, the therapeutic approach taken by Ms B’s organisation has now had to give way to a more restrictive regime, authorised by the Court of Protection. She has constant 2:1 care with a third carer on standby in case they are needed during any period of severe dysregulation.

On 21 August 2025, KP had a telephone consultation with the British Pregnancy Advisory Service (“BPAS”), followed by a face to face consultation on 27 August 2025. BPAS considered that KP had complex mental health needs and they would not be the appropriate service to undertake termination of the pregnancy. The specialist NHS referral hospital nearest to where KP lives also declined referral but the Applicant Trust accepted her as a patient. KP lives a long way from where the Trust operates but it is clearly to be welcomed that she is under the care of specialists in complex pregnancies.

BPAS raised concerns with the Trust about KP’s capacity to decide whether to terminate the pregnancy. Multi-disciplinary and multi-agency meetings did not resolve the issue and a formal assessment was arranged, to be undertaken by Dr A. Dr A had seen Dr Rippon’s capacity assessments. Some concerns were raised before me as to how an NHS Trust might swiftly gain access to documentation from Court of Protection proceedings to which it has not been a party, in circumstances where the material might well be relevant to important decisions regarding P’s capacity and best interests. I shall not consider that broader issue in this judgment but it is something that the Official Solicitor indicated she might raise outside these proceedings.

Dr A was assessing KP’s capacity to decide on termination or continuation of pregnancy. Dr A told me that she found KP to be defensive and to give short answers. KP did not disclose any reasoning or thinking behind her change of view about termination. In her written assessment, Dr A concluded:

“It is clear that, in this current persona, P can repeat back the mechanics of the surgery, the risks, and the implications of termination…. In the context of changing personas and overall mental health presentation, however, P does not understand the effect this has on her decision making. This is to the degree that it impacts on her ability to understand and weigh up decisions relating to the termination. It is also likely that it impacts on P’s ability to retain the information… There is a significant risk that P will present as a different persona on the day of the initial termination process (where mediation is taken to end the viability of the pregnancy) or when she comes back the next day to surgically remove the fetus or indeed in the days subsequent to the termination should her persona change … This has led me to form the view that P lacks capacity to make a decision about the termination, or, at the very least, that her capacity fluctuates according to her persona at the relevant time.”

Ms B speaks to KP for about two hours every week. She knows her very well indeed. She said, and it is evidently the case, that until the pregnancy and more particularly the events following the spotting, KP had made good progress in her current placement and that it is in her interests to remain there. Ms B considered that in her current mental state KP could not care for a baby or young child – it would not now be feasible. She told the Court that she was very reluctant to give a view as to whether termination was in KP’s best interests because in the future KP might resent the decision and lose her trust in Ms B and the care team. For example, whereas Ms B says that at the time when KP was having sexual relations with CD she was in a period of mental wellness - she was herself and was not governed by a persona at the time - now KP regards that as a “manic” phase when she was not herself and when she ought to have been given greater protection by being placed under restrictions. She believes that she should not have been allowed to become pregnant. KP regards whatever is her current persona as her normal self. Hence, Ms B fears that KP could lose trust in her and the care team if she views them as being responsible for making what she later thinks was an unwise decision. Currently, KP is adamant that she wants the pregnancy to be terminated but, as and when her mental health improves, she may have a different view.

I note the transcript of an MDT meeting on 28 August 2025 when Ms B said of KP:

“She's also recognising that if when she comes out of this and resets [she] will regret the termination, and she believes that she will then enter a period of psychosis and then become a risk to a life because she's ended the life of the baby. So it's a really difficult situation. This young lady doesn't know which way she wants to go. She just wants an end and the end that she can see is end the baby's life. But when she was more capacious [sic.] she was very much I can't live with myself if I end a baby's life. She wanted this child.”

Dr A advised that from 19 weeks of pregnancy the risks of severe bleeding from surgical termination were much higher than they are currently at 17 weeks. A decision needs to be made now. Medical termination of pregnancy would be inadvisable for KP because it would be likely to be very difficult and distressing for her. Surgical termination would take place in one day, not over two days as she had indicated in her written capacity assessment. It would involve the insertion of dilapan rods into the cervix during the morning and surgical termination under general anaesthetic in the afternoon. When KP was under general anaesthetic the contraception implant would be inserted under her skin. A very careful and sensitive care plan has been drafted which allows for a pause in the process up to the insertion of the rods. There are two stages when restraint might be necessary and the plan sets out a proportionate, staged approach. Members of KP’s usual care team would travel with her to the hospital. Indeed, they would stay overnight with her at nearby accommodation on the eve of the procedure. If, for example, she became resistant to the administration of general anaesthetic, they would first talk her through it. Only if all other measures were to fail would a short period of physical restraint be used to facilitate the administration of anaesthetic.

Ms B told me that KP still has some contact with her adoptive mother who is broadly supportive of her current choice to have the pregnancy terminated. CD maintains a relationship with KP. He has no impairments, works, and is clearly capable of making decisions for himself. Whilst he was supportive of KP’s initial wish to continue the pregnancy he is now supportive of her decision to terminate it because he thinks that continuation of the pregnancy is harmful to her mental health.

I have been provided with a very helpful attendance note by Ms Burridge-Todd, a solicitor instructed to represent KP in the COP welfare proceedings, who saw KP on 23 September 2025 to discuss the decisions before this Court. KP was very clear that “I want the abortion. I’ve always wanted it … it is pissing me off that I have had to wait for this, it should have been done weeks ago.” She also stated that she wanted the contraception implant: “put it in when I am under.” She said she had had an implant before. She described herself as “loud, gobby, opinionated and hilarious.” She said, “I don’t mind others making decisions for me, so long as they have my best interests at heart. They can’t be snowflakes about it. I am sick of that game.” She seemed to blame a lack of restrictions for her having become pregnant and now to want more restrictions to keep her safe. KP was sure that she did not want to speak to the judge hearing her case.

Mental Capacity Act 2005 (“MCA 2005”) s1 sets out the principles which apply for the purposes of the Act and ss2 and 3 govern the Court’s approach to capacity. MCA 2005 s4 concerns the determination of a protected person’s best interests. For the sake of economy I shall not set out those provisions in full in this judgment. It is helpful to consider the clear guidance from the Supreme Court in A Local Authority v JB [2021] UKC 52:

“[66] Section 2(1) requires the court to address two questions.

[67] The first question is whether P is unable to make a decision for himself in relation to the matter. As McFarlane LJ stated in York City Council v C at para 37, “the court is charged in section 2(1), in relation to ‘a matter’, with evaluating an individual’s capacity ‘to make a decision for himself in relation to the matter’.” The focus is on the capacity to make a specific decision so that the determination of capacity under Part 1 of the MCA 2005 is decision-specific as the Court of Appeal stated in this case at para 91. The only statutory test is in relation to the ability to decide. In the context of sexual relations, the other vocabulary that has developed around the MCA, of “person-specific”, “act-specific”, “situation-specific” and “issue-specific”, should not be permitted to detract from that statutory test, though it may helpfully be used to identify a particular feature of the matter in respect of which a decision is to be made in an individual case. For instance, “the matter” in this case cannot be described as being “person-specific” as there is no identified person with whom JB wishes to engage in sexual relations.

[68] As the assessment of capacity is decision-specific, the court is required to identify the correct formulation of “the matter” in respect of which it must evaluate whether P is unable to make a decision for himself: see York City Council v C at paras 19, 35 and 40.

[69] The correct formulation of “the matter” then leads to a requirement to identify “the information relevant to the decision” under section 3(1)(a) which includes information about the reasonably foreseeable consequences of deciding one way or another or of failing to make the decision: see section 3(4).

…

[78] … the second question that the court is required to address under s 2(1) is whether that inability is 'because of' an impairment of, or a disturbance in the functioning of, the mind or brain. The second question looks to whether there is a clear causative nexus between P's inability to make a decision for himself in relation to the matter and an impairment of, or a disturbance in the functioning of, P's mind or brain.

[79] The two questions under s 2(1) are to be approached in that sequence."

Capacity to decide whether to terminate a pregnancy has been considered on more than one occasion. Munby J held in Re X (A Child) EWHC 1871 (Fam):

“[6] In a case such as this there are ultimately two questions. The first, which is for the doctors, not this court, is whether the conditions in section 1 of the 1967 [Abortion] Act are satisfied. If they are not, then that is that: the court cannot authorise, let alone direct, what, on this hypothesis, is unlawful. If, on the other hand, the conditions of section 1 of the 1967 Act are satisfied, then the role of the court is to supply, on behalf of the mother, the consent which, as in the case of any other medical or surgical procedure, is a pre-requisite to the lawful performance of the procedure. In relation to this issue the ultimate determinant …. is the mother’s best interests.

[7] …. Two things flow from [the fact that the statutory conditions for a lawful termination are met]. In the first place this court can proceed on the basis (sections 1(1)(a) and (c)) that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, to the life of the pregnant woman or of injury to her physical or mental health or (section 1(1)(b)) that the termination is necessary to prevent grave permanent injury to her physical or mental health. Secondly, if any of these conditions is satisfied the court is already at a position where, on the face of it, the interests of the mother may well be best served by the court authorising termination.”

In S v Birmingham Women’s and Children’s NHS Trust and Another [2022] EWCOP 10, HHJ Hilder, sitting as a Deputy High Court Judge, identified the information relevant to a decision to terminate pregnancy as being:

“[52] … (a) what the termination procedures involve for S (‘what it is’);

(b)

the effect of the termination procedure/the finality of the event (‘what it does’)

(c)

the risks to S’s physical and mental health in undergoing the termination procedure (‘what it risks’);

(d)

the possibility of safeguarding measures in the event of a live birth.”

The last piece of information is directed to the possibility of public authorities taking safeguarding measures to protect the newborn child. HHJ Hilder was concerned with the specific case before her. For the purpose of the case before me I would add, “the risks to KP’s physical and mental health from continuing the pregnancy (what deciding not to do it risks).”

The information relevant to a decision about contraception was considered by Bodey J in In re A (Capacity: refusal of contraception) [2011] Fam 61, and by Cobb J in The Mental Health Trust & others v DD [2014] EWCOP 13 with further observations by me in Re EE (Capacity: Contraception and Conception) [2024] EWCOP 5.

When determining KP’s best interests, the Court is enjoined to consider not only her medical interests, but her interests in a much wider sense: social, emotional and psychological. The dicta of Baroness Hale in Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67 at paragraph [39] are often cited:

“The most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of that treatment for the patient is likely to be; they must try and put themselves in the place of the individual patient and ask what his attitude to the treatment is or would be likely to be; and they must consult others who are looking after him or interested in his welfare, in particular for their view of what his attitude would be.”

KP’s rights under Article 3 and Article 8 of the European Convention on Human Rights are engaged.

After hearing oral evidence I received submissions from Ms Watson KC for the Applicant Trust and Ms Gollop KC for the Official Solicitor on behalf of KP. They agreed that KP lacks capacity to make the decisions whether to terminate the pregnancy and whether to have a contraceptive implant. They differed on whether termination of her pregnancy was in KP’s best interests but agreed that if she had a termination procedure it was in her best interests for it to be surgical rather than medical and that it would be in her best interests to have a contraceptive implant when under general anaesthetic for the surgical termination.

Ms Watson KC maintained that KP’s own current wishes had weight. There would be significant risks to her physical and mental health were the pregnancy to continue. She had already tried to take matters into her own hands by inserting a coat hanger and she could cause herself severe harm by making further attempts to self-induce termination. She could also thereby injure or even kill the baby which would have long term adverse consequences for KP’s mental health. Those who are interested in her welfare – her adoptive mother and her boyfriend – support the view that the termination should go ahead in KP’s best interests, as do healthcare professionals at the Trust.

Ms Gollop KC told the Court that after very careful consideration and “with trepidation” the Official Solicitor considered it not to be in KP’s best interests to undergo termination of her pregnancy. The Court should try to ask what the attitude of this patient is or, if that cannot be ascertained, what her attitude would be likely to be to the proposed termination. When KP was mentally well she wanted the pregnancy to continue to term and to give birth to the baby. As her mental health deteriorated, she asked to be taken care of and to be protected from making unwise decisions. When she recovers her mental health, she is likely retrospectively to consider termination to have been an unwise decision which will harm her mental health and jeopardise her trust in her current care team and therefore her placement. Her autonomy is best protected by following the wishes she held before she became mentally unwell and before the current persona took her over.

The Applicant Trust and the Official Solicitor both contend that KP lacks capacity to make the decision to terminate her pregnancy and to have a contraceptive implant. I agree. This is a difficult issue and I do not intend to criticise Dr A’s written assessment but it was only after hearing the oral evidence from her and Ms B that I was persuaded that KP lacks capacity in relation to these decisions. Dr A’s written assessment was less compelling: she referred to KP’s inability to understand and weigh up “decisions” rather than the information relevant to the decisions. She referred to an inability to retain information because of a possible change in persona by the time the termination procedure was commenced. However, a change of persona might lead to a change of decision rather than an inability to retain the information relevant to that decision. Nevertheless, having heard Dr A and Ms B give evidence, it is clear that KP cannot understand, or weigh or use, information about the reasonably foreseeable consequences of deciding to undergo termination of pregnancy or deciding not to do so. Information relevant to the decision regarding termination of a pregnancy includes information about what termination risks, and what continuation of the pregnancy risks. KP cannot understand information about the potential impact of termination (or of continuation of the pregnancy) on her mental health. She cannot understand that she might feel differently in the future about the decision than she does now or that the consequences of her decision might include a negative impact on her mental health. That inability is related to her changing personas. When in the grip of a particular persona she cannot foresee a change in persona and therefore cannot understand how, in a different persona or without any adopted persona, she will view or experience the outcome of a decision made earlier. For the same reason she cannot weigh or use such relevant information. A decision to terminate a pregnancy or to continue necessarily has long term consequences and so the relevant information includes information about those consequences. The same is true, albeit to a lesser extent, of the decision about contraception. No amount of support is capable of helping KP understand and weigh or use this relevant information. Her inability is because of an impairment of or a disturbance in the functioning of her mind or brain.

The evidence of both witnesses established that KP had prepared hard for her capacity assessment with Dr A. She was determined to be found to be capacitous. She had carried out research and she had prepared answers. She is capable of retaining relevant information once she has understood it, at least for a sufficient period to enable her to make a decision. She stuck to her script and said to staff afterwards words to the effect that it was exhausting to do so. She was able to repeat information about the mechanics of termination but not about the impact on her of termination or of continuation of the pregnancy. Having heard the evidence of Ms B it is obvious that Dr A’s perception that KP was defensive and giving only the shortest answers, was due to KP having prepared certain answers with a view to “passing” her capacity assessment, and then rigidly sticking to them throughout. As Dr A experienced, KP was unable to engage when asked about relevant information that she had not prepared for.

I conclude that at this time KP lacks capacity to make decisions about termination of pregnancy.

I conclude similarly in relation to the provision of contraception. KP can explain the mechanics and retain such information. She cannot however understand, or weigh or use, information about the reasonable consequences of deciding to have or not to have contraception. That is because of her current inability to comprehend the consequences of the decision in future times when she might have a different or no adopted persona.

A termination of pregnancy would be lawful and, as Munby J noted, its lawfulness is not only a necessary requirement before any consideration could be given to making a best interests decision about undergoing a termination, but also indicates what medical opinion is of the balance of harm to the mother involved in the decision whether or not to terminate the pregnancy. However, I have a duty, outwith the ambit of the Abortion Act 1967, to consider KP’s best interests in the widest sense and just because the termination would be lawful under the 1967 Act, it does not follow that the Court must give its consent on P’s behalf.

I know that Dr A and the clinicians at the Trust whose care KP is under, support the proposal for a termination. Her adoptive mother and her boyfriend, who is the father of the unborn baby, also support the proposal for termination. Their main shared concern is the adverse impact on KP’s mental health from the continuing pregnancy.

KP is suffering a mental health crisis as demonstrated by her escalating self-harm and dysregulation. She has long suffered from mental health challenges but, having demonstrated an improvement, she has more recently deteriorated during the pregnancy. On the evidence received there is no prospect of a sudden or marked improvement whilst she remains pregnant. That is not to say that she is likely to improve immediately upon termination of the pregnancy, but it is foreseeable that so long as she remains pregnant her mental health will continue to be poor and may well deteriorate further.

Her current mental health state puts her at risk of physical harm. The evidence is that she has harmed herself due to the pregnancy. On the balance of probabilities, whether in a genuine attempt to produce a termination or not, she has inserted something into herself causing bleeding. She has cut her abdomen. She is distressed by not having her wishes to undergo termination respected. I was told by Ms B that KP has recently reported feeling the baby’s movements and that this has added to her distress. As the pregnancy continues the physical impacts of it on KP will only become more evident to her and, in all likelihood, more distressing.

I have to contemplate the prospect of KP’s pregnancy going to term, or almost to term, and her delivering a child. In her present mental state and given her present adamant wish to terminate the pregnancy and her distress that her wishes are not being respected, that is a very troubling prospect. A decision that it is not in her best interests to undergo a termination of pregnancy is a decision to continue the pregnancy. If a further application were made for a decision to terminate at a later stage in the pregnancy, that would have to be on the basis that KP had suffered even greater harm that she has suffered to date. The termination of pregnancy would be more problematic at a later stage and after 24 weeks termination would only be lawful if necessary to prevent grave permanent injury to KP. In the absence of any change rendering a later termination lawful and in KP’s best interests, it is likely that KP would eventually give birth either by elective Caesarean section or after going into labour. Thus, one foreseeable consequence of overriding KP’s present wishes would be to authorise – she and others might say to force - a mother against her will to carry a child for a further 20 weeks or so and then to give birth. A very strong justification would be required for such a significant interference with KP’s Convention rights.

A termination would prevent further physical harm to KP caused by self-harm due to her unwanted pregnant state and/or attempts to self-induce a termination of pregnancy. There is a real risk of such physical harm occurring. It has already begun. As the pregnancy continues the risks of severe bleeding or other forms of harm from KP’s own interventions will only increase. There is a real risk that KP could harm the baby by her attempts to induce a termination. If KP were to harm the baby then that in itself could have a severe adverse effect on her mental health both in the short and longer term.

In her current mental state KP could not look after a new born baby. As noted, there are no grounds to expect that her mental state will improve whilst she remains pregnant. It seems to me likely that if the pregnancy were to result in a live birth, then the baby would be the subject of an interim care order and be removed from KP’s care. That is what she says she fears the most because she does not want to put another child through what she has gone through as a child in care. Having her baby removed from her would be highly detrimental to KP’s welfare and her mental health.

Set against these considerations is the concern, articulated on behalf of the Official Solicitor, that it would be contrary to KP’s best interests to terminate a pregnancy which, when she was not mentally unwell, she wanted to continue. There is a prospect of her regaining capacity in the future and being distraught that her wish to continue the pregnancy had not been followed. Her currently stated wishes must be treated with great caution since she is currently incapacitous and adopting the persona of a 13 year old girl rather than speaking for her 19 year old self, as previously she did. This was the concern expressed by Ms B at the MDT meeting on 28 August 2025 (paragraph 16 above).

This is not an easy issue but in my judgement these concerns, whilst relevant to the best interests analysis, do not justify the weight the Official Solicitor has given them:

I have no evidence that KP holds beliefs or values that would be likely to influence her decision if she had capacity and which should be taken into account when considering her best interests. I am not aware of her practising any religion or holding any ethical beliefs opposing termination or contraception in principle.

The Court does not have the luxury of time – there is no opportunity to wait and see if KP’s mental health improves or if she can regain capacity to make a decision about termination.

KP’s history of dysregulation and challenging behaviour is such that were she to have a live birth after this pregnancy, there is as very real prospect that she would be unable to care for the child throughout its infancy and childhood. She might in the future be in a better position to have a child and look after it safely and well but that is not likely in the present circumstances. It would be highly detrimental to her mental health for KP to have her child removed from her care.

The evidence satisfies me that if termination of pregnancy is to be performed then it would be in KP’s best interests for it to be a surgical rather than a medical termination. That would be less distressing and difficult for KP. I have to take into account the possibility that KP will not be compliant during the processes necessary for a surgical termination and that elements of the care plan involving the brief use of physical restraint will need to be deployed. Such experiences will cause her distress.

Termination of pregnancy is a once and for all decision – a termination cannot be reversed. KP might become pregnant again and, in different circumstances, may continue a pregnancy to a successful birth but the baby she is now carrying will be lost forever. The consequences of deciding to terminate the pregnancy are profound and are liable to affect KP in ways which are not entirely predictable. Similarly, a decision not to terminate the pregnancy would have profound, lifelong consequences. The Court has to consider the best interests of KP at this particular time but, in accordance with MCA 2005 s4(2), has to “consider all the relevant circumstances” which must include the potential long term impact on KP of deciding one way or the other.

This is not a straightforward decision but having considered all the relevant circumstances, KP’s past and present wishes and feelings, any views and values likely to influence her decision if she had capacity, and the views of those engaged in caring for her or interested in her welfare, I have decided that it is in KP’s best interests for her termination of her pregnancy to be performed as soon as it can be arranged and in accordance with the care plan submitted by the Applicant Trust. Having analysed the relevant considerations I have concluded that particular weight should be given to protecting KP’s current mental health. There is uncertainty as to what her longer term response to termination will be but there is certainty as to her current wishes and her current poor mental health to which her continuing pregnancy is clearly a very significant contributor. I am very concerned that KP would perceive any other decision as forcing her to continue an unwanted pregnancy. KP is a severely traumatised young woman and to compel her to continue her pregnancy and to give birth to a child against her will would be likely to cause further significant trauma. It is possible that she will respond very negatively to having had a termination but that cannot be reliably predicted. What is predictable is that her ongoing dysregulation and self-harm is likely to continue and worsen as the pregnancy continues.

It is important that KP understands, now and in the future, that she is not currently capable of making a decision whether or not to terminate her pregnancy. The decision cannot wait and so it is being made now, on her behalf in her best interests. The decision maker is me, a Judge in the Court of Protection. I am responsible for the decision to consent on her behalf to a termination of her pregnancy. Her care team and Ms B are not responsible for the decision. They have given their full support to KP. The medical and nursing team at the Applicant Trust are likewise focused entirely on caring for KP. Many skilled and caring individuals are doing their best to help her but they have left the decision whether or not to terminate the pregnancy to the Court. That is the Court’s role and a decision has to be made. For the reasons given I have decided that it is in KP’s best interests for a termination of pregnancy to be performed.

The contraceptive implant can be inserted when KP is under general anaesthetic. It will cause her no pain or significant discomfort. She wants that to be done but she lacks capacity to make the decision. The proposal has the support of the clinicians caring for her. KP had vaginal sexual intercourse when she was telling others that she was not doing so. The pregnancy was unplanned. There is a risk of her repeating that conduct in the future with the detrimental welfare consequences that have occurred with this pregnancy. Her current mental health is poor and it would be clearly contrary to her best interests for her to become pregnant again following the imminent termination of pregnancy. She remains in a relationship with CD. The implant can be removed with no longer term consequences if she were to regain capacity and decide to cease contraception. There are no significant adverse physical affects from the implant and if there were any, it could be removed. Having considered all the relevant circumstances I am sure that it is in her best interests for KP to have the contraceptive implant which can be inserted when she is under general anaesthetic during the termination procedure.

For these reasons I grant the application made by the Trust and declare that it is lawful for KP to undergo a surgical termination of her pregnancy and to have a contraceptive implant inserted under the skin of her arm, in accordance with the treatment plan submitted to the Court.