AlphaMED Resources · https://alphamedicine.uk/Resources/cases/sudiksha-thirumalesh

Sudiksha Thirumalesh and mental capacity

She was 19, awake, and wanted to try an experimental treatment abroad. A judge decided she could not make that choice for herself. Ten months after her death, the Court of Appeal said the judge had got it wrong.

Updated 12 October 2026 (2 minute read)

AutonomyBeneficence
  1. Admitted to intensive care
  2. Judge rules she lacks capacity
  3. She dies, aged 19
  4. Court of Appeal overturns the ruling

Summary

  • Sudiksha Thirumalesh was a 19 year old from Birmingham with a rare mitochondrial disease, which stops the body's cells producing enough energy.
  • From 1 August 2022 she lived in intensive care on a ventilator, fed by tube and on dialysis every other day.
  • Her doctors at University Hospitals Birmingham believed she was dying and wanted to plan palliative care.
  • She wanted to travel to the US or Canada for an experimental therapy. She told a psychiatrist, "I want to die trying to live. We have to try everything."
  • The hospital asked the Court of Protection to approve a palliative care plan. The court first had to decide whether she had capacity, the legal term for being able to make a decision for yourself.
  • On 7 August 2023 Mrs Justice Roberts ruled that she did not, because she did not believe what her doctors were telling her. Both psychiatrists who assessed her told the court that she did have capacity.
  • She died on 12 September 2023.
The Royal Courts of Justice in London, where the Court of Appeal sits

Dig deeper

  • On 31 July 2024 the Court of Appeal set the ruling aside. The judges said the law contains "no specific requirement of belief".
  • They also said the first judge had not properly explained why she disagreed with both experts.
  • The court had allowed her to be called only "ST" while she was alive. Her family could name her publicly from 22 September 2023.
  • In October 2026 it is still the leading case on whether a patient has to believe their doctors in order to have capacity. The Mental Capacity Act has not been changed in response.

Ethical issues

PrincipleHow it applies here
AutonomyThe Mental Capacity Act 2005 assumes every adult can make their own decisions, and an unwise decision does not take that away. To lack capacity a person must be unable to understand the information, remember it, weigh it up or communicate a choice. The Court of Appeal held that a patient is allowed to disagree with a prognosis.
BeneficenceHer doctors believed more treatment would not help and wanted to plan a comfortable death. No patient can make doctors give a treatment they consider futile. With capacity she would still have kept the right to refuse care and to look for it elsewhere.

Interview questions

  • What is mental capacity, and how is it assessed?
  • A patient who has capacity refuses to accept that she is dying. Does that change how you treat her?
  • How would you tell the difference between a patient who is hopeful and a patient who has not understood?
  • Can a patient demand a treatment that their doctors think will not work?
  • Why did the Court of Appeal overturn the first ruling?
  • Should patients be free to raise money for experimental treatment abroad?
  • Why might a court stop a patient from being named, and is that fair to the family?

Sources

  1. The National Archives, case lawcaselaw.nationalarchives.gov.uk/…/896
  2. legislation.gov.uklegislation.gov.uk/…/3
  3. The National Archives, case lawcaselaw.nationalarchives.gov.uk/…/40

Photo: David Castor, CC0, via Wikimedia Commons, colour altered.

Practise answering these with a mentor

Our interview preparation has you answer questions like these out loud, with feedback on each answer.

See interview preparation Book a free consultation

alphamedicine.uk/Services · alphamedicine.uk/Contact

Related

Indi Gregory and best interests AutonomyBeneficence Indi was eight months old and had a disease with no cure. Her parents wanted treatment to continue, and a hospital in Rome offered to take her. Judges in England ruled that it was in her best interests to stop. ADHD and autism overdiagnosis debate AutonomyBeneficence Far more people in England are diagnosed with ADHD and autism than 25 years ago. People disagree over whether ordinary difficulties are being given medical labels, or people who were missed for years are at last being recognised. A government review reported on 9 October 2026 that it could not show overdiagnosis on a large scale, partly because the data are out of date. It wants help to be given on need, without waiting for a diagnosis. Corridor care in NHS hospitals AutonomyBeneficence Corridor care means looking after patients in corridors, waiting rooms and other parts of a hospital never built for it, because every bed is full. The government and NHS England both call it unacceptable. NHS England still counted about 3,300 patients a day in September 2026.

More NHS hot topics, medical ethics case studies and medical school interview questions are in AlphaMED Resources, which we add to and update through the application cycle.