Doctors told court that 50-year-old woman ‘C’ was mentally unfit after she demanded right to die because life had lost ‘sparkle’ but judge ruled she had ‘unusual’ personality

In reports, the court judgment was billed almost as a judicial rebuke for a life lived frivolously: a 50-year-old woman who battled in court for the right to die as her existence had lost “sparkle” and she did not wish to age and lose her looks.



The woman, identified only as C, was avowedly “impulsive and self-centred”, said high court judge Alistair MacDonald in a ruling which detailed her four marriages, heavy drinking, ambivalent parenting and desire to end her life following financial downturns and health damage from a failed suicide attempt.

But at the heart of the case of C, who died this week after MacDonald rejected the attempts of doctors to declare her mentally unfit to decline life-preserving dialysis, is another issue. How unconventional, selfish and bloody-minded can a person be before they are deemed to have a mental disorder?

Some psychiatrists argue C should never have had to go to court, and that doctors remain over-keen to give clinical labels to behaviour that is deeply unconventional but no more.

“I don’t think this lady should be diagnosed with personality disorder,” said Peter Tyrer, professor of community psychiatry at Imperial College London, who chairs a World Health Organisation (WHO) panel currently revising guidelines on the condition.

“She decided she didn’t want to go on living because she didn’t want to be old. I don’t think that, in itself, constitutes significant inter-personal dysfunction.”

Most right-to-die cases involve chronically or terminally ill people who are seeking the help of others to end their lives. But C, mother to three daughters and reluctantly grandmother to an infant boy she complained made her feel “past her sell-by date”, was refusing dialysis to repair liver and kidney damage from an overdose of pills washed down with Veuve Clicquot.



Patients, as MacDonald’s ruling noted, have a right to refuse treatment. However, this can be overridden if a court agrees they don’t have the mental capacity to properly decide.

This was the view of two psychiatrists from King’s College hospital in south London, where C was being treated. They told the court that C refused to believe doctors’ assurances her liver and kidneys could recover from the overdose, and her behaviour was “petulant” and “catastrophic thinking”.

They diagnosed C with histrionic or narcissistic personality disorder, a classification from the US-based DSM diagnostic system, which is commonly used along with the now under-review WHO method.

Both have their drawbacks, explained Thomas Fahy, professor of forensic mental health at King’s College London: “Personality is a continuum. Deciding where the precise boundary lies between what is the normal range of personality and a disorder is always difficult.”

While systems like DSM guide doctors methodically through a series of possible signs for personality disorder, the scientific evidence behind them “is a little rocky”, Fahy added.

Tyrer said the revised WHO system will instead see personality as more of a sliding scale. “This patient wouldn’t qualify, in my view, for personality disorder on that spectrum, given the tributes from her daughter and other people in her life,” he said.

“She had a lifestyle that could be unusual, but we ought to be celebrating diversity and we shouldn’t make everyone fit a common design. It wasn’t a life which was causing harm to others in a significant way.”

One of the paradoxes is that, read in this context, MacDonald’s long and detailed chronicle of C’s chequered life reads not as a criticism but a defence of her decision-making capability. C’s vehement rejection of a life of uncertain health and certain advancing age was not a disorder; it was simply who she was.

While C herself was too ill to give evidence, MacDonald heard from two of her three daughters – the third is aged 15 – and produced a comprehensive summary of what he memorably called “a life characterised by impulsive and self-centred decision-making without guilt or regret”.

Amid her marriages and numerous affairs, the judge wrote, C had “spent the money of her husbands and lovers recklessly before moving on when things got difficult or the money ran out”.

He added: “In particular, it is clear that during her life C has placed a significant premium on youth and beauty and on living a life that, in C’s words, ‘sparkles.’”

MacDonald also described C’s consistent desire to die: on being diagnosed with breast cancer aged 49, she said she was “actually kind of glad because the timing was right”. Soon afterwards she had a relationship breakdown and her business failed, putting her in significant debt.

In September, C tried to kill herself, and was transferred from her local hospital to King’s. It was here that she began to refuse dialysis, prompting the hospital trust to go to the court of protection to seek permission to force the treatment.

MacDonald rejected the psychiatrists’ view that C’s reasons were irrational: “Although they are not reasons that are easy to understand, I believe that they are not only fully thought through, but also entirely in keeping with both her (unusual) value system and her (unusual) personality.

“Her unwillingness to consider ‘a life she would find tolerable’ is not a sign that she lacks capacity; it is a sign that what she would consider tolerable is different from what others might. She does not want any life that is on offer to her at this stage.”

• This article was amended on 7 December 2015. A quote from Peter Tyrer was changed at his request to more accurately reflect the professor’s commitment to destigmatising the term personality disorder.

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here