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This Case is Not About Eugenics

DD (who we’ll call Deirdre) is a 36 year old woman with a full scale IQ of around 70 (the average range is 85 – 115, the actual average being 100). She is mother to six children aged between six months and 12 years, although she has no contact with any of them, and five of them have been adopted. This is not because she has been prevented from seeing them; rather, it is because she does not want to see them. Instead she lives with her partner, BC (let’s call him Brian), who has a full scale IQ in the region of 62. The two have been in a long term relationship, but it has been characterised by arguments and shouting.

This case is not just one hearing. There have been a number of judgements relating to Deirdre, and it is in this most recent judgement (which you can see here: http://www.bailii.org/ew/cases/EWCOP/2015/4.html#para20) that Mr Justice Cobb explicitly stated this case “is not about eugenics”.

To really understand something (so Jonathan Rhys Meyers’ Henry VIII tells us) you have to go back to the start.

So Let’s go Back to the Start

Deirdre has been known to social services for most of her life. She was at an early age the subject of a child protection plan because of concerns her parents were mistreating her, and it is unclear whether there was also an element of sexual abuse. It was apparent from an early age her intellectual functioning was impaired and she was provided with special education. She did not leave home until she was 24, at which point she went to live with her then partner, TJ (Ted, for us), a man with mild learning difficulties. That was in 2002.

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Later the same year, Deirdre gave birth for the first time. This was to a son (who we’ll call Alfie), born by emergency caesarean, required due to foetal distress in labour. Deirdre and Ted took Alfie home and although they were supported by social services, they struggled to cope. A sequence of incidents of escalating seriousness meant that after four months, Alfie was placed with his paternal grandparents, with whom he still lives. There has not been contact between Deirdre and Alfie for many years.

Three times in 2003, and once again in 2004, Deirdre requested she be sterilised. It was noted she was very young for this and in any event she may not have the capacity to make such a decision, and she was not sterilised.

Deirdre and Ted later separated.

Refused to Engage with Professionals

In 2008 Deirdre met Brian, with whom she began a new relationship, and she was soon pregnant again, although both she and Brian denied this when the possibility was raised with them. Adult services attempted to support them but Deirdre and Brian refused to engage with professionals, rejected advice, and ignored attempts to assist them.

Towards the end of the pregnancy, Deirdre visited the local hospital to get treatment for a UTI, and when midwife services were alerted, the pregnancy was finally, undeniably, confirmed. An ante-natal check at that time revealed the baby was breech, and Deirdre was persuaded the baby would therefore need to be delivered by C Section. She was however determined this should not be before the due date. Accordingly, when the due date came, the C Section was performed. Because of the incidents with Alfie, and the refusal to engage throughout the pregnancy, Deirdre’s newborn daughter (who we’ll call Beth) was the subject of an Emergency Protection Order, and was not allowed to go home with Deirdre and Brian.

Instead proceedings began, and the parents were comprehensively assessed. Both Deirdre and Brian denied they had any difficulty in understanding and wanted any record alleging this to be destroyed. They did not attend the final hearing and missed contact sessions arranged for them to see Beth.

Under Delusions

Deirdre appeared at this time to be under some delusions, and claimed a famous actor was her father, and an equally well-known opera singer (who is actually younger than Deirdre) was her mother. She alleged she had been born in New Zealand but kidnapped by the adults who raised her. On the occasions when Deirdre would see Beth she would take a photograph of the opera singer and show it to Beth, stating “this is your grandmother”. In the end contact did not progress and Beth never went to live with Deirdre and Brian. She was adopted.

By March 2010, staff in Children’s services had come into contact with Deirdre, and believed she was again pregnant. Again Deirdre denied this. This time she did not develop a UTI nor any other ailment that pressed her to attend any kind of medical appointment, and it was not until June 2010, on a routine home visit, that Deirdre was found cradling a baby (who we’ll call Chris) believed to be five – 10 days old, who had been born in her home, which was described as unhygienic. Chris was seriously dehydrated and undernourished, and it was fortunate he had been found. It appears Brian and Deirdre had attempted to feed him with cup-a-soup, and he had lesions on his head caused by Brian assisting in the delivery with Bar-B-Q tongs, although Deirdre later denied this.

Deirdre was also mentally and physically unwell, and was diagnosed with a delusional disorder, for which she was prescribed medication, and a seriously distended bladder for which she required catheterisation. Chris was admitted to hospital, and it was found he had a hole in his heart. Brian and Deirdre were both formally cautioned for child neglect, and Brian was reported to be ashamed of his actions, although Deirdre not. Chris, like Beth, was adopted.

Another Pregnancy

In 2011, another pregnancy was suspected and again denied, and during a routine visit to the home Deirdre was observed to be extremely unwell. She was fitting and unconscious. Brian was not able to say how long Deirdre had been so very unwell. She was rushed to hospital as an emergency and needed ventilation on the intensive care unit. It was discovered she had suffered an intracerebral embolism causing fitting, probably brought about by pregnancy. Monitoring of the unborn child revealed evidence of foetal bradycardia (slowing of the heart and consequent distress). An emergency C Section was required for the sake of both mother and baby. Deirdre suffered post-partum haemorrhage, and needed two units of blood, and her fourth child (who we’ll call Debbie) was very premature, at 29 weeks.

Neither Deirdre nor Brian displayed any interest in Debbie. She was, like her siblings, adopted.

Significantly, Deirdre resisted prophylactic injections to prevent further blood clots. The occurrence of the embolism meant that any future pregnancy carried an increased risk of stroke and of haemorrhaging.

In 2012, Deirdre became pregnant once more. Again it was concealed from social and adult services, who were sometimes refused access to the property during regular visits they routinely made to Deirdre and Brian.

In mid-July an unannounced visit by social workers was made and Brian refused them entry. There were protracted negotiations that included discussion of potential police attendance, and in the end, Brian relented. Upon entry, social services saw Dierdre was attempting to breast feed a baby (Emily), who was swaddled in a dirty, bloodied pillow case. The home was again unhygienic. There were no baby clothes, bottles, nappies, or anything else suggesting preparation for a child.

Deirdre was asked where the afterbirth was, and was evasive; concern grew that it had not been delivered, as Deirdre was again evidently unwell. Brian handed Emily to social services and gave permission to have her examined in hospital. Thereafter neither he nor Deirdre asked to see her again. Inevitably, Emily became the next of Deirdre’s children to be adopted.

A sixth child (who we’ll call Frankie) was born in 2014, following another difficult and concealed pregnancy and eventual C Section, over which parties attended court on more than one occasion. Frankie is also now in care, probably to be adopted.

Another Pregnancy Could Kill Deirdre

It was determined at that time another pregnancy, especially if concealed, could very well kill Deirdre. Her doctors, in Frankie’s delivery, noted Deirdre’s uterus was now extremely thin, increasing the risks associated with pregnancy to extremely serious levels, and with her history of difficult deliveries, the possibility of her dying could not be ignored.

And that is how we got here, to the statement “this case is not about eugenics”. The Court ordered Deirdre be taken to hospital for therapeutic sterilisation, as well as ordering she be given all therapeutic care and treatment required. Further, the Court authorised the use of reasonable and proportionate measures to ensure Deirdre attended her appointment.

Sometimes what is best for us is not what we want. In 2002, it certainly seems, Deirdre may have wanted to be sterilised, although she may not really have understood what that meant. At various times across the course of the six births detailed above she was using contraception, but not reliably. At the time Deirdre asked to be sterilised, it was not in her best interests to undergo such extreme surgery.

However, 12 years and five births later, we see how the best interests of a person are not fixed. There is rarely one answer that will be right for any of us throughout our lives, particularly in sensitive circumstances. This is why considering the “bests interests” of a person is not always easy, especially where there are any issues over capacity. This is why it is usually necessary to obtain expert advice.

This case is not about eugenics; it is about the changing best interests of Deirdre.