Judge considers man’s freedom to make choices ‘for his own bad’

A judge has detained a disabled man in hospital after two psychiatrists clashed over his capacity to make decisions concerning his health and welfare.

The man, aged in his 40s, has acquired brain injury and other serious health difficulties and needs a wheelchair for mobility. He previously refused to be treated for sepsis until he became very ill and various care placements broke down over two decades due to his behaviour, the court was told.

The president of the High Court, Mr Justice Peter Kelly said this difficult case raised legal and medical issues including about a person's freedom to make decisions "for his own bad", rather than his own good.

A psychiatrist who treated the man had assessed him as lacking, due to a personality disorder, capacity to make decisions on his health and welfare and opposed lifting an order for his detention in hospital, made last month after a care placement broke down.

The doctor opposed lifting the order for reasons including he feared the man, because of impulsive decisions in the past consequent on his personality disorder, would suddenly leave there and end up homeless which would pose a serious risk to his life and health.

A second psychiatrist, appointed by the court to assess the man for a possible ward of court application, disagreed he was of unsound mind and said he had capacity to make decisions concerning his treatment.

Voluntarily

The man, through a solicitor, sought to have the detention order lifted and said he would voluntarily remain in the hospital.

Because of the second psychiatric report, recently received, the judge returned the matter to Wednesday.

There is no basis to detain a sentient human being who, for their own reasons, refuses treatment even if others consider their refusal “stupid or unsafe”, the judge said.

The issue for determination was soundness of mind and the court’s dilemma was the conflict between the psychiatrists.

Having heard the evidence, he concluded the “prudent and sensible” thing was to continue the man’s hospital detention and permit staff administer all treatments considered in his best interests. He took account of the man’s “strong views”, these were not “punitive” orders and a report should be prepared by another psychiatrist concerning the clash of views between the two psychiatrists on the personality disorder issue.

The man’s solicitor earlier told the judge his client strongly opposed detention and disagreed he was of unsound mind. The man disputed evidence from a social worker team leader concerning his behaviour towards staff and considered problems arose because he was not provided with a specific care team and also denied throwing urine and faeces at staff.

The man is a very spiritual person, the court was told.

The team leader said she and the man’s parents believe the hospital is the best place for him and the detention orders should continue. Otherwise, they feared he might impulsively leave the hospital and end up homeless because various previous placements broke down due to his sometimes abusive behaviour towards staff. Those concerns must be seen in the context of the man requiring a wheelchair for mobility, catheter replacement and having a serious viral illness.

The man, she agreed, has been “largely co-operative” in hospital and also made progress at an earlier care facility. She agreed his self-care improved, he could leave that facility by wheelchair, use public transport and open a bank account. He had a “rich” online world where he got supports but also used that to engage in abuse of staff dealing with him, she said.

In reply to the judge, she agreed the man can be “cantankerous but also very pleasant”.