The Supreme Court judgment in Maguire – a brief analysis

On 21 June 2023 the Supreme Court handed down its eagerly and long awaited judgment in R (Maguire) [2023] UKSC 20, unanimously dismissing the appeal challenging the Coroner’s determination at the conclusion of the inquest into Ms Maguire’s death that the evidence was not supportive of an assertion that the death may have arisen from a violation of the positive obligation under ECHR Article 2 to protect life.

This determination consequently limited the jury’s conclusions under section 5(1) of the Coroners and Justice Act 2009 (CJA), such that a standard conclusion limited to “how” the deceased came by their death would be returned. Mrs Muriel Maguire, Jackie’s mother brought a judicial review claim against the Coroner’s determination, which was dismissed by the High Court with the Court of Appeal dismissing the resulting appeal. 

Prior to the Supreme Court’s dismissal of the appeal, questions arose as to whether, in their consideration of whether there was an arguable breach of the systems duty or operational duty by the care home or other healthcare providers, there would be a movement towards the application of Article 2 in healthcare case. The Supreme Court’s decision, as Morahan did, continues to curb the application of Article 2 in  healthcare inquests. 

By way of brief background, Jackie Maguire was a vulnerable adult who died on 22 February 2017. She had been living in a care home and was subject to a DoLS. The day prior to her death paramedics were called to the care home sought to transfer Jackie to hospital but she was uncooperative. Following that a GP advised that if Jackie was still refusing to be transferred to hospital that she should be monitored in the care home. A transfer to hospital took place on 22 February but Jackie passed away that day. 

In considering the systems duty and whether there was an arguable breach by the care home or other healthcare providers so as to trigger the enhanced procedural obligation, it was emphasised that in the healthcare context (where the systems duty operates at a high level) it will only be rare cases that it will be found to have been breached. The same approach applied in care homes and the systems in place at the care home were capable of being operated in a way which would ensure that a proper standard of care was provided to residents, even though there may have been individual lapses in putting them into effect. In relation to other healthcare providers, again whilst criticisms could be made of individuals these related to individual lapses as opposed to a failure of the systems duty. The Supreme Court found that Coroner was entitled to find that there was no arguable breach of the systems duty.

In considering the operational duty the Supreme Court highlighted that when an individual is placed in a care or nursing home or hospital the state does not assume responsibility for all aspects of their physical health; therefore the focus is on specific risks to health, which in Jackie’s case the authorities were aware of. The circumstances of each case must be considered and the operational duty applies in a graduated way depending on the perception of the risk based on reasonable assessment and taking reasonable steps accordingly. None of the healthcare professionals involved in her care was on notice that Jackie's life was in danger and the Supreme Court concluded that there was no arguable breach of the operational duty by any of the healthcare providers. 

This is a shoring up of the position following Morahan and provides further clarity on the application of Article 2 in healthcare related inquests. 

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If you would like to discuss the issues raised in the Maguire case, please contact Claire Petts or Judith Duffin.

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