Anorexic patients feels ashamed over coercive feeding orders, court told

Specialist says Mental Health Act does not address situation where patient refuses to be fed

Mr Justice Peter Kelly said he hoped an eating disorders specialist will get an opportunity to make known her views about the need for changes in the law to allow for coercive feeding treatment to be administered without court intervention.  Photograph Nick Bradshaw for The Irish Times

Mr Justice Peter Kelly said he hoped an eating disorders specialist will get an opportunity to make known her views about the need for changes in the law to allow for coercive feeding treatment to be administered without court intervention. Photograph Nick Bradshaw for The Irish Times

 

An eating disorders specialist has expressed serious concern to the president of the High Court that doctors have to go to court to get orders to coercively feed patients with anorexia.

Mr Justice Peter Kelly said the specialist, with “good justification”, perceived a defect in the Mental Health Act, leading to a “cumbersome” situation where feeding orders have to be sought from the court, with “adverse” consequences for some, including patients.

The specialist expects feeding order applications to increase as new eating disorder services come on stream here and said some patients feel distressed and ashamed about being the subject of court orders to coercively feed them.

The Mental Health Act, unlike in several other jurisdictions, does not specifically address a situation where a patient refuses to be fed via naso-gastric tube. Restraint guidelines set by the Mental Health Commission continue to be regarded as preventing coercive feeding without court permission, she outlined.

Mr Justice Kelly said he hoped she will get an opportunity to make known her views about the need for changes in the law to allow for such treatment to be administered without court intervention.

The court has its own jurisdiction to direct totally private hearings of applications for orders for medical treatment and he would consider any such application, he said.

The issue was raised on Tuesday when the judge was dealing with the case of one of the specialist’s patients, a young woman with a long history of anorexia and psychiatric illness and depression.

Orders

Last month, he made orders permitting the woman be detained in hospital and tube fed after being told she had not eaten for a week and had made two serious suicide attempts.

He was told the woman believes she is grossly obese and hears voices telling her she does not deserve to eat and live when she was in fact seriously underweight for her age and build.

The specialist, a consultant psychiatrist considered, due to hallucinations, delusions and an underlying psychiatric illness, she then lacked capacity to make decisions about her welfare.

When the case returned on Tuesday, the judge was told the woman has received a range of treatments, including electro-convulsive therapy, and has made such a “miraculous” physical and psychiatric recovery that various medical reports had concluded she now has capacity to make decisions about her health.

In those circumstances, the judge granted Paul Brady BL, for the HSE, an order discontinuing wardship proceedings.

The psychiatrist said her view was she should have been able to tube feed the woman without having to come to court last month as that application distressed the woman.

In exchanges with the judge, she said hub units offering specialist facilities for adults and children with eating disorders are being developed here. She anticipated it could take five years before the court would hear the last application to send people with chronic eating disorders to the UK for specialist treatment.

The judge said, if the ability to treat all such cases here is to be acquired, that was “to be welcomed”.

He welcomed the news of the woman’s “extraordinary” physical and psychiatric recovery but regretted she had decided against coming to court herself because she was too nervous, stressing there was “no need to be nervous”.

The woman painted a very optimistic view of her future in her letter and he hoped her wishes for herself “will all come to be realised”.