Clarifying the rights of vulnerable people detained in health and social care settings

Does the State owe a duty to provide lifesaving medical treatment under Article 2 of the European Convention of Human Rights (ECHR) to a vulnerable person deprived of their liberty in a care home under Deprivation of Liberty Safeguards (DoLS)?

Jackie Maguire had Down's syndrome and learning disabilities. She lacked capacity to make decisions about her living arrangements, care and treatment. She was detained in a care home under the Mental Capacity Act’s deprivation of liberty safeguards (DoLS).

She fell ill several days before she died in 2017 aged 52. There were delays in medical care, she did not cooperate with attempts to take her to hospital and by the time she was admitted, it was too late. Her family alleged multiple failings by care home staff and medical professionals. 

At the inquest into her death it was decided that Jackie’s case did not meet the test for an ‘Article 2’ ECHR inquest. This meant that the inquest jury could not comment on the alleged failings by those caring for her.

The Court of Appeal dismissed an appeal of this decision brought by Jackie’s mother. It decided that while a death in a care home resulting from abuse or neglect would engage Article 2, it would go beyond Strasbourg caselaw to decide that Article 2 was engaged in this case.

Jackie’s mother appealed to the Supreme Court. We applied to intervene.

We were involved to help clarify the law.

Our intervention aimed to clarify that people who are deprived of their liberty in a care home under DoLS have the same level of human rights protection under Article 2 to lifesaving treatment as those who are detained by the state such as prisoners and involuntary psychiatric patients.

It was an opportunity to promote the rights of people in health and social care institutions, by arguing that the State’s duty to provide lifesaving medical treatment should extend to people who are deprived of their liberty by the State in care homes and other settings.

We were granted permission to intervene and made legal submissions to the Supreme Court hearing in November 2022. 

We argued that people like Jackie Maguire, who are detained under DoLS because they lack the capacity to decide their care and where they should live, should be owed the same level of human rights protection (under Article 2) as other vulnerable groups, such as those detained in mental health hospitals, prisons or police custody. This would have allowed the jury at Ms Maguire's inquest to comment on the alleged failings by those caring for her.

The Supreme Court decided that people who live in care homes who are deprived of their liberty for their own good are not in the same situation as prisoners and other similar groups. They have the same human rights protections that apply to the general population. 

The Supreme Court dismissed the appeal by finding that where an individual who lacks capacity is placed in a care home, nursing home or hospital, the state does not accept responsibility for all aspects of their physical health. The duty under Article 2 is to ensure that they have access to the healthcare available to the general population.        

It also held that even for those detained such as prisoners and psychiatric patients, the state only accepts responsibility for specific risks to life of which it was aware or ought to have been aware, and risks connected to the reason why the individual is detained (e.g. for psychiatric patients, the risk of suicide).

Read the full judgment of Maguire v HM Senior Coroner for Blackpool and Fylde.

Although the case was unsuccessful, it raised important issues around standards of care provided to vulnerable people. The judgment clarified the current understanding of the law.

We believe that Jackie should have had the same human rights protections as others deprived of their liberty, where the state has additional responsibilities for them.

We will continue to argue for further protections for the most vulnerable members of our society, and hope that in the future deaths like this can be prevented.