Whether or not to be vaccinated against COVID-19 is a matter of personal choice. A family judge robustly made that point in declining to authorise vaccination of a care home resident suffering from acute dementia who had fiercely objected to the procedure.

The 86-year-old woman believed that she was living in the late 1940s or early 1950s, that her long-deceased parents were still alive and that she worked at a cake factory where she had been employed in her youth. Every day at 4pm, when the factory siren once signalled the end of the working day, she would grab her handbag and jacket and attempt to return to her childhood home.

The care home where she lived had suffered a shocking toll during the first COVID-19 lockdown. Of its 99 residents, 27 had died from infection with the virus. Faced with her resistance to vaccination, the judge was asked to consider authorising her inoculation on the basis that it was in her best interests. The plan was to employ gentle restraint and sedation in vaccinating her.

Ruling on the matter, the judge found that she lacked the mental capacity to make any decisions for herself. She had received admirably insightful and sensitive care at the home and the application was driven by a desire to protect her. Nobody could sensibly doubt the efficacy of the vaccination programme, yet she had consistently and volubly opposed undergoing the procedure.

Although her reality was undoubtedly delusional, that did not stop it being her reality and her views were worthy of recognition and respect. Given that all but one of the home's other residents had been vaccinated, and that she kept herself apart from others and received almost no visitors, the risk of her becoming infected was slight. The risk would, however, increase as the home opened up to the outside world.

Whether due to her worsening dementia or as a result of her personality traits and general approach to life, she was increasingly resistant to medical interventions of any kind. A suggestion had been made that she be tricked into having the vaccine by telling her that her father – who was still very much alive in her mind – wanted her to have it. However, the judge ruled that such an artifice, although well-intentioned, would risk compromising her dignity and suborning her autonomy.

The judge found that, were she to have capacity to choose for herself, she would probably elect not to be vaccinated. There was no question of her being supine or passive if she felt that she was being inoculated against her will. Use of sedation and restraint would risk undermining her trust in those caring for her. Overall, the judge ruled that vaccinating her could not be said to be in her best interests.