High Court permits woman’s hospital detention for treatment of severe anorexia

Judge says he has ‘no choice’ but to continue his orders despite the strong wishes of woman and her husband

The High Court president has made orders permitting the continued detention of a woman with severe anorexia in hospital to protect her constitutional right to life.

Mr Justice David Barniville said on Thursday he had “no choice” but to continue the earlier orders against the strong wishes of the woman and her husband.

It was a difficult decision, he said, but he was satisfied the orders curtailing her liberty were necessary to vindicate her constitutional rights, including her right to life.

“If she was not getting such good care, I am afraid it is unlikely she would be with us today,” he said, adding that the case is kept under close review.

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The Health Service Executive (HSE) sought the original orders, including permitting tube feeding, in “really extreme” circumstances last January, when the woman’s weight was very low, the judge said.

Doctors also have the power to restrain and sedate the mother, who is in her 40s, but have not needed to act on them due to her commitment and co-operation with intensive treatment, he said.

She has been doing everything asked of her, causing her weight and body mass index to increase. However, he said, the improvement has occurred because of the treatment and support she is receiving.

Doctors have advised him that she continues to show eating disorder cognitions and he weight is still “very very low”, bringing with it a “very high risk of medical complications”.

The medical evidence before him is that she continues to require detention in hospital for now.

He had earlier heard from the woman’s husband, who asked him to let her return home. Sitting in a hospital room for the last few weeks has been “very very stressful” for her, particularly as a mother away from her family, he told the court.

Mr Justice Barniville acknowledged the situation is “horrible” for them but said she suffers from a “really awful condition”. She has been doing well in hospital with treatment from doctors who are doing “everything they can to try to help her get through this”, he said.

The evidence suggests it would not be safe for her to return home, even if her family has the best of intentions, he told the man. The woman faces a long road to recovery and the family needs to take it “step by step”, he added.

He acceded to the application from the HSE, represented by barrister Ciara Dowd, for a continuation of the earlier orders. The woman’s court-appointed advocate, Aileen Currie, said there is an intention to engage an independent psychiatric consultant to consider the woman’s case.

Consideration will be given to permitting outings from the hospital, but these would not be safe at present, the judge said, as he adjourned the case for just under a month.

Separately, he heralded a rare good news story in his list dealing with people who require court assistance because they lack the mental capacity to make their own decisions.

The case concerned a woman in her 80s who was admitted to hospital last month because she was ill physically, mentally unwell, suffering from delirium and refusing food and treatment. At the hospital’s request, he made orders on February 14th providing for her effective detention and tube feeding.

The strong evidence at that point was that she lacked mental capacity and her life would have been at risk without the orders, which were “clearly necessary”, he said.

On Thursday, solicitor Natasha McKenna, for the hospital, said the woman seems to have “very significantly turned a corner” and is responding well to treatment. For that reason, the hospital was not seeking further orders, and it is expected she will ultimately progress to a step-down unit, said Ms McKenna.

Solicitor Niall McGrath, who was appointed by the court to advocate for her interests, said the woman has experienced a “remarkable turnaround in her fortunes”. She was previously somewhat fatalistic about her prospects but this has changed, he said.

Mr Justice Barniville said doctors’ reports show the woman is now eating with support and, while she has medical issues, she is much more engaged in her care now that her paranoia has improved significantly.

Her overall outlook is more positive and she is happy to remain in hospital for now, which is a decision she now has capacity to make. It is an understatement to say her situation has “dramatically improved”, and that is a testament to her medical team, he added.

He had “no hesitation” in agreeing to the hospital’s request.

Ellen O'Riordan

Ellen O'Riordan

Ellen O'Riordan is High Court Reporter with The Irish Times