Court allows doctors to force feed patient refusing food and fluids

A psychiatric patient who has been refusing food and fluids in recent weeks may be force fed if doctors consider that is necessary and appropriate, the president of the High Court has directed.

The woman, in her 40s, suffers from a number of psychiatric conditions, including post-traumatic stress disorder, arising from being sexually abused as a child.

While she had told treating doctors she did not want to die, she also believed death was the only way she could get certain images out of her mind, the court heard earlier this week.

The Health Service Executive had initiated an application last week for orders permitting it to administer food and fluids to the woman who, the court heard then, had been refusing food and had taken only very small amounts of fluids for the previous two weeks.

Before that, she had been fed via a nasogastric tube for some time, and she began refusing food and fluids after the tube was removed last month.

Last Friday, Mr Justice Nicholas Kearns granted a temporary order allowing the HSE to administer fluids, after being told that her doctors feared she was at risk of imminent death unless her intake of fluids increased.

Fluids and nourishment

On Tuesday, the judge was told the woman had agreed to take fluids and nourishment for the next two weeks and on that basis, he agreed to adjourn the case to later this month.

However, yesterday, the HSE, represented by Shane Costelloe SC, said the woman was refusing to accept food and he wanted orders allowing doctors to feed her, by means including a nasogastric tube, without her consent.

Feichin McDonagh SC, for the woman, said she had “sipped some lemonade” and he had no instructions to oppose the HSE’s application.

Mr Justice Kearns granted orders allowing doctors to feed the woman and said medical practitioners were entitled to take whatever steps they deemed were required to help her.

It had not been necessary to make such orders, given the woman’s attitude, on Tuesday, he said. This was a “very, very difficult situation” for all involved.

The woman was admitted to the psychiatric facility last year after incidents of self-harm. When the HSE first sought the feeding orders last week, she opposed the HSE’s application, but her husband supported it.

Emotional disorder

In addition to PTSD, the woman suffers from an emotional disorder and eating disorders arising from her experience of sexual abuse during her childhood.

Despite treatment, her situation has not improved and her food and fluid intake dropped in recent months.

She was fed via a nasogastric tube up until late September but, since it was removed, had barely eaten or taken fluids and expressed her wish to those treating her that she be allowed to die.

The case raises legal issues not previously dealt with by the Irish courts, including whether the woman has the necessary mental capacity to refuse food and fluids which would result in her death.

The court previously heard that three medical professionals, including a consultant physician and a consultant psychiatrist who have treated the woman, believed she lacks the necessary capacity.

Another consultant psychiatrist disagreed and expressed the view the woman is fully aware of what she has chosen to do.