The High Court has lifted a temporary injunction that prevented doctors from administering an antipsychotic injection and restraining a patient against his will.
The order was put in place on Friday by Mr Justice Brian O’Moore to allow for the issues to be heard urgently by the High Court over the weekend.
The Health Service Executive (HSE) had intended to give the medication that day to the man, aged in his 40s, who has a long-standing medical condition and has been involuntarily detained at an acute psychiatric unit under the Mental Health Act of 2001 since December.
Mr Justice O’Moore said on Friday that the medical evidence allowed for delaying the administration of the antipsychotic injection for about a day, but he was “in the dark” about the impact of further delay.
Barry O’Donnell, senior counsel for the HSE and the treating psychiatrist, said the patient is “profoundly unwell” and his detention was approved by a mental health tribunal.
Ms Justice Niamh Hyland heard the case on Saturday, extending the orders until she delivered her judgment on Sunday.
In her ruling, she accepted there was a fair issue to be tried in the case but it appeared to her “overwhelmingly obvious” that the balance of justice favoured lifting the orders.
The patient wanted the court to keep the injunction in place until his full case has been heard and determined. The man’s solicitor said he has been taking antipsychotic medication for the last 20 years to please his family and his doctors but now wants to stop.
He blames the injections for various side effects.
The man, through his counsel, argued that non-consensual treatment is allowed only when it is formally found that a person is incapable of giving consent due to their mental disorder.
Although two doctors concluded he lacked capacity to consent to treatment, he submitted the lack of a formal determination as to his capacity is unlawful and breaches his rights to respect for his dignity, autonomy and mental integrity.
Ms Justice Hyland noted the plaintiff was restrained twice in December against his will for a two-minute period so the injection could be given. It is clear from the hospital’s policy that restraint has been carefully considered and is only used in clearly identified circumstances that are monitored and recorded, she said.
She was told by the HSE that delay to treating the patient with the medication would result in a deterioration of his mental state. The psychiatrist concluded the man’s mental state had already declined and he was becoming more paranoid, hostile, violent, unpredictable and had increasing religious and persecutory delusions, she said.
A delay to treatment would also add to the length of time he would need to remain in hospital due to his mental illness, the doctor submitted, adding that he may now need faster-acting medication to counter the worsening of his condition.
Unusually, the judge said, the patient submitted that the principal detriment he would face if the treatment was continued was the illegality of the procedures. She said he did not allege that he would be medically disadvantaged by the medication or identify a better form of treatment.
No medical evidence was advanced to controvert that from the HSE doctors, she said.
The detriment identified by the HSE “far outweighs” that advanced by the patient of the risk of being treated unlawfully, she held.
In bringing the proceedings, she said, the patient has ensured there is independent oversight by the court of the medical conclusion as to his capacity and of the administration of treatment between now and the determination of his case.
