BAILII is celebrating 24 years of free online access to the law! Would you consider making a contribution?
No donation is too small. If every visitor before 31 December gives just £1, it will have a significant impact on BAILII's ability to continue providing free access to the law.
Thank you very much for your support!
[Home] [Databases] [World Law] [Multidatabase Search] [Help] [Feedback] | ||
England and Wales Court of Appeal (Criminal Division) Decisions |
||
You are here: BAILII >> Databases >> England and Wales Court of Appeal (Criminal Division) Decisions >> McCarthy v R. [2019] EWCA Crim 2202 (11 December 2019) URL: http://www.bailii.org/ew/cases/EWCA/Crim/2019/2202.html Cite as: [2019] WLR(D) 678, (2020) 172 BMLR 92, [2019] EWCA Crim 2202, [2020] 4 WLR 45, [2020] Crim LR 749, [2020] 2 Cr App R (S) 5 |
[New search] [Printable PDF version] [View ICLR summary: [2019] WLR(D) 678] [Buy ICLR report: [2020] 4 WLR 45] [Help]
ON APPEAL FROM WOLVERHAMPTON CROWN COURT
HHJ Nawaz
T20177055
Strand, London, WC2A 2LL |
||
B e f o r e :
LORD CHIEF JUSTICE OF ENGLAND AND WALES
THE HONOURABLE MR JUSTICE SWEENEY
and
SIR RODERICK EVANS
____________________
BRENDAN PATRICK McCARTHY |
Appellant |
|
- and - |
||
REGINA |
Respondent |
____________________
Mr J Hankin QC (instructed by Crown Prosecution Service) for the Respondent
Hearing dates: 10 October 2019
____________________
Crown Copyright ©
The Rt Hon The Lord Burnett of Maldon:
Introduction
The facts
i. To perform any cosmetic surgery in the United Kingdom the doctor concerned must, by statute, be listed on a Specialist Register held by the General Medical Council. The GMC has issued guidelines and rules to the effect that, before a procedure is carried out, the surgeon must meet the patient on at least two occasions; must explain the potential complications and risks; and must allow a two-week cooling off period before surgery is performed to enable a patient to change their mind.
ii. In addition, cosmetic surgeons will be on the lookout for potential psychiatric or psychological problems, such as Body Dysmorphic Disorder, and will, if necessary, refer the patient for psychiatric or psychological assessment before deciding whether to conduct the relevant procedure.
iii. In all cases proper informed consent would be obtained and recorded in approved forms.
iv. In any event, tongue splitting would never be done by a reputable surgeon, whether for aesthetic or any other purposes. There are also particular risks associated with the procedure. The tongue will bleed very heavily; it is liable to swell up; it will be hard to keep sterile; there is an ever-present risk of infection; and creating a forked tongue has the potential for an adverse effect on both speech and feeding.
v. Likewise, a plastic surgeon would not remove a nipple for aesthetic reasons, only for medical reasons.
vi. Removal of the external structure of an ear (the pinna – which catches sound and funnels it into the ear canal), whether partial or total, would never be done by a surgeon for aesthetic reasons, only for medical reasons and under sterile conditions in an operating theatre. Removal causes much bleeding and, given that the ear canal carries a lot of bacteria, there is an enhanced risk of infection which would need to be addressed in follow-up appointments. The removal could cause closing of the ear canal (which would be difficult to reverse) and could result in moderate to severe conductive hearing loss which could be irreversible. Extensive excision could also potentially cause injury to the facial nerve with the possibility of consequent facial paralysis, together with practical difficulties in relation to the wearing of glasses or use of a hearing aid.
vii. Whilst photographs showed that the ear procedure on Mr Lott had been done quite well, in the sense that the skin edge had been cleanly cut, the stitching was not done to the standard of a plastic surgeon.
The sentencing hearing
i) that the appellant had performed irreversible surgery without anaesthetic and with profound long-term consequences;
ii) that really serious injury, even consented to, brought with it the risk of disease or even death, and could impose substantial financial cost on society as a whole;
iii) that the protections provided to patients of qualified medical practitioners were not available to the appellant's customers;
iv) that the appellant had unlawfully administered Adrenalin and Lidocaine;
v) that he had failed to ensure a sterile environment when he operated; and
vi) that he had performed the procedures for commercial gain.
Grounds of Appeal & submissions
1. The judge erred in determining that the offending was so serious that only an immediate sentence of imprisonment was justified.
2. The judge should not have characterised the harm caused as "greater harm" for the purposes of the Guideline.
3. Insufficient, if any, weight was attached to the fact that each of the individuals had consented to the procedures.
4. Too great an emphasis was placed on the need for deterrence.
5. The judge failed to conduct an adequate assessment of the additional factors pointing towards a suspended sentence, and the imposition of an immediate sentence was wrong in principle, given that:
a) The appellant had pleaded guilty;
b) The appellant had demonstrated significant remorse;
c) The appellant posed a low risk of future re-offending;
d) There was a realistic prospect of rehabilitation;
e) The appellant was of effective good character and his offending was out of character.
f) The appellant had strong personal mitigation;
g) The offending took place a number of years before sentence.
6. In the alternative, for the same reasons, the sentence was too long.
Discussion
"In short, we see no good reason why body modification should be placed in a special category of exemption from the general rule that the consent of an individual to injury provides no defence to the person who inflicts that injury if the violence causes actual bodily harm or more serious injury……The appellant's argument envisages consent to surgical treatment providing a defence to the person performing the surgery whether or not the person is suitability qualified as a doctor, and whether or not there is a medical (including psychological) justification for the surgery. Even were we attracted by that argument, which we are not, such a bold step is one that could only be taken by Parliament".
i. There is a general interest of society in limiting the approbation of the law for significant violence, albeit inflicted with consent [39].
ii. There is some need to protect from themselves those who have consented, most particularly because they may be vulnerable or even mentally unwell [39].
iii. Serious injury, even consented to, brings with it the risk of unwanted injury, disease or even death and may impose on society as a whole substantial cost [39].
iv. What the appellant undertook for reward was a series of medical procedures performed for no medical reason [42].
v. The professional and regulatory structure which governs how doctors and other medical professionals practise is there to protect the public [42].
vi. The protections provided to patients, some of which were referred to in the medical evidence before the judge (above), and which include reputable medical practitioners not removing parts of the body simply when asked to do so by the patient, were not available to the appellant's customers or more widely to the customers of those who set themselves up as body modifiers [42/3].
vii. The protection of the public in the context of body modification extends beyond the risks of infection, bungled or poor surgery or an inability to deal with immediate complications, to the protection of those seeking body modification – many of whom will be vulnerable and some of whom will be suffering from an identifiable mental illness [43].
viii. The personal autonomy of his customers did not provide the appellant with a justification for removing body modification from the ambit of the law of assault [44].
Conclusion