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BMJ. 2007 October 13; 335(7623): 743.
PMCID: PMC2018817

Mother asks surgeons to perform hysterectomy on daughter with cerebral palsy

The High Court in London may be asked to decide whether a 15 year old girl with cerebral palsy and severe learning disabilities should have a hysterectomy at the request of her mother.

Alison Thorpe, of Billericay, Essex, went public last week with her plea that her daughter Katie, said to have a mental age of 18 months, should have the operation to prevent her going through the pain and discomfort of menstruation.

The disability charity Scope warned that the case could set a “disturbing precedent.” Andy Rickell, the charity's executive director, said, “It is very difficult to see how this kind of invasive surgery, which is not medically necessary and which will be very painful and traumatic, can be in Katie's best interests.

“This case raises fundamental ethical issues about the way our society treats disabled people and the respect we have for disabled people's human and reproductive rights.”

However, a few precedents already indicate that the courts will look at each case on its facts. Judges will sometimes consider a hysterectomy to be in the best interests of a severely mentally disabled woman or girl but will incline to a less drastic option.

If the case comes to court Katie will be represented by the official solicitor, who will take his own expert medical advice. Precedents suggest that before authorising such an invasive procedure the court may want to wait to see whether her periods do interfere with her quality of life.

The first such case, known as re D, was in 1975. An 11 year old girl with Sotos' syndrome and an IQ of 80 was booked to have a hysterectomy at her mother's request, but the case went to the High Court after the head teacher of the girl's school and the social worker involved with the family objected.

The judge, Mrs Justice Heilbron, ruled that given the girl's level of intelligence and the fact that she might marry the operation would be a violation of her right to reproduce.

In the leading case, re B, in 1988, the House of Lords upheld decisions of the High Court and Court of Appeal approving a sterilisation operation (occlusion of the fallopian tubes, not hysterectomy) on a girl of 17 who had epilepsy and a mental age of five or six. The operation was allowed on the basis that it would not be in her best interests to become pregnant.

In two later cases, re Z and re SL in 1999 and 2000, both involving adults—one aged 19 and one 29—the High Court ruled in favour of a laparoscopic subtotal hysterectomy, to prevent pregnancy and to stop menstruation, although the judgment in re SL was later overturned by the appeal court, which said that a Mirena coil should be tried first.

A spokeswoman for Mid Essex Hospital Services NHS Trust said that the trust was still taking legal advice on the issue.


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