A severely anorexic young woman must be kept in hospital despite her fear of contracting Covid19 there because doctors consider her death is inevitable if she is discharged, the president of the High Court has ruled.
"If I send her home, I am effectively deciding there is no more life," Mr Justice Peter Kelly said.
The mother of the 19-year-old woman had supported her daughter’s wish to be discharged, disagreeing that it would likely lead to her death, and said she would do everything she could to persuade her to take food supplements.
“She’s my daughter, I’m fighting for her life.”
The judge said his decision was “very difficult” and of the sort that “will haunt one” as to whether it is correct or not, which only time would tell.
The unanimous evidence of the treating team is the woman’s anorexia is so severe it must be treated in hospital and cannot be treated in the community, he said.
“I do not want to consign her to end of life care at the age of 19.”
He believed her best interests were served by “choosing life” and leaving her in hospital, giving her some chance of recovery from anorexia and “living a full life”.
The woman, a ward of court, had appealed to the judge via email to be discharged from hospital with an assisted living arrangement or community care regime, saying she believed she would contract Covid-19 if she remained there and doctors were signing “my death warrant”.
Her mother told the judge on Tuesday she supported her daughter’s request and was willing to care for her in either her own or her son’s home.
The judge told the mother that doctors considered her daughter’s condition is so serious she requires continuing hospital treatment, including intensive naso-gastric feeding not possible in the community and, if discharged now, that could only be for palliative care.
The mother replied: “She would be with me and I will look after her.”
Ward of court
Her daughter had said a doctor had told her there was a “great possibility” she will contract Covid-19 in hospital, she added.
“If she gets Covid-19, I won’t be able to visit her and she will be alone.”
The young woman has a long-standing history of anorexia involving several hospital admissions after previous attempts to care for her at home and in the community failed.
She was made a ward of court on foot of medical reports, as a result of anorexia, as she lacked capacity to properly weigh up treatment options.
Lawyers for the HSE, the hospital, and her wardship committee opposed discharge.
The judge said this was a “heart-rending” case and there was no doubt the woman wants to leave the hospital as she has a deep-seated fear she will contract Covid-19 which she considered a greater risk to her life than her anorexia.
The law requires the court to decide what is in her best interests while also taking into account her views and those of her family, he said.
On the evidence, including that the risk to her life is much higher if she was to leave hospital in her current medical state, he considered her best interests required she stays in hospital as that gave her a better chance of a full life.
While he knew his decision would disappoint the woman and her family, he had done the best he could and must lean in favour of her life. He wished the woman and her family the very best and said he was “very sorry” they were in this position.