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   Case summaries      Savage v South Essex NHS Trust

 
Savage v South Essex NHS Trust [2009] 2 WLR 115  House of Lords

 
 
In 2004 Mrs Savage walked out of Runwell hospital where she was being detained and treated in an acute psychiatric ward. She walked 2 miles and then threw herself under a train and died. Her daughter brought the action claiming that the hospital, as a public authority, had failed to protect her mother's right to life under Art 2 ECHR by allowing her to escape. Art 2 imposes a positive obligation on the state and public authorities to take adequate steps to protect life. The question for the court was whether this includes a duty to prevent suicide in psychiatric patients.


Held:

Art 2 did impose a positive obligation to prevent suicide. The matter should go to trial to determine if the health authority had taken adequate steps to protect life.

"as a public authority, the Trust was under a general obligation, by virtue of article 2, to take precautions to prevent suicides among detained patients in Runwell Hospital. So the Trust had, for example, to employ competent staff and take steps to see that they were properly trained to high professional standards. The hospital's systems of work - and, doubtless, also its plant and equipment - had to take account of the risk that detained patients might try to commit suicide. When deciding on the most appropriate treatment and therapeutic environment for detained patients, medical staff would have to take proper account of the risk of suicide. But the risk would not be the same for all patients. Those who presented a comparatively low risk could be treated in a more open environment, without the need for a high degree of supervision. Those who presented a greater risk would need to be supervised to an appropriate extent, while those presenting the highest risk would have to be supervised in a locked ward. The level of risk for any particular patient could be expected to vary with fluctuations in his or her medical condition. In deciding what precautions were appropriate for any given patient at any given moment, the doctors would take account of both the potentially adverse effect of too much supervision on the patient's condition and the possible positive benefits to be expected from a more open environment. Such decisions involve clinical judgment. "