The right to die or to refuse medical treatment is a complex issue that has been the subject of debate for many years. It presents considerable legal, as well as moral, difficulties.

Recently, the Court of Protection had to decide whether a 36-year-old woman with paranoid schizophrenia and a long history of drug abuse should be allowed to refuse a major operation.

The woman, who is presently 'sectioned' and lives in detention in a mental health unit, had been diagnosed with ovarian cancer. Although she was concerned that the proposed surgery could result in her being unable to have children, she initially agreed to the operation, but it had to be cancelled after she suffered a psychotic episode.

After she had again agreed to have the surgery, it was rescheduled, but her approved mental health practitioner then raised the question of whether she had the necessary mental capacity to give informed consent to it.

The Court had firstly to consider whether the proposed treatment was in the woman's best interests and, after hearing expert evidence, concluded that it was.

The Court heard evidence of the woman's 'florid' psychosis, which included considerable delusions and a lack of insight into her own condition. Among the delusional behaviour she was suffering from were voices telling her she would not come to harm if she did not have the surgery.

The Court ruled that the operation should go ahead.