Hospital can detain man for urgent colonoscopy against his wishes – court

Man with suspected bowel cancer is ‘extraordinarily vulnerable’, court told

The president of the High Court, Mr Justice Peter Kelly, was told the man refuses to accept his illness or that he requires a colonoscopy and doctors believe he lacks capacity to appreciate how serious his condition is. Photograph: Aidan Crawley

The president of the High Court, Mr Justice Peter Kelly, was told the man refuses to accept his illness or that he requires a colonoscopy and doctors believe he lacks capacity to appreciate how serious his condition is. Photograph: Aidan Crawley

 

A hospital can detain an “extraordinarily vulnerable” man with suspected bowel cancer for the purpose of performing an urgent colonoscopy on him against his wishes, the High Court has ordered.

The president of the High Court, Mr Justice Peter Kelly, was told the man refuses to accept his illness or that he requires a colonoscopy and doctors believe he lacks capacity to appreciate how serious his condition is.

Aged in his 40s, the man’s father died after undergoing surgery for bowel cancer and that “unfortunate experience” has probably influenced the man’s thinking, the judge said. On the basis of medical evidence, the judge on Thursday granted Mairéad McKenna, for the HSE, orders permitting the man’s detention in hospital for the purpose of performing a colonoscopy.

The orders were made in the context of a petition to have the man made a ward of court and based on the view of two doctors the man lacks capacity to make decisions on his treatment.

The judge directed a further capacity assessment on the man be done by a court-appointed medical visitor and returned the matter to next week when he will be told the results of the colonoscopy.

In his ruling, the judge noted the man, from a non-EU country, has lived here for a considerable time and is a “very good worker”.

Having noticed blood in his stool for a considerable period, and feeling weak and tired, the man had gone last month to the hospital’s emergency department where he was triaged and a nurse noted he was unwell, pale and dehydrated. A blood test revealed his haemoglobin was critically low and he was transfused with several blood units.

A CT scan showed a large mass in his colon area which immediately raised the possibility of surgical intervention and a consultant surgeon took over his care. The judge said the evidence is that a colonoscopy is necessary, not just because of the man’s symptoms but also because his father had previously been diagnosed with bowel cancer and died after surgery. It was considered the man would require surgery but he had declined to be involved in any of the procedures doctors wish to perform.

The surgeon shared the view of a consultant psychiatrist the man lacks capacity to consent to treatment and has a psychotic disorder, the judge noted. As well as the concerns about capacity, there were also concerns the man might leave the hospital, he said. This man is “extraordinarily vulnerable” with fluctuating haemoglobin levels, low body weight and very weak and the medical view is that treatment is in his best interests, he said.

Given the evidence on capacity, and the fact of a petition to have the man made a ward of court, the judge said he would direct a wardship inquiry.

In the interim, he was satisfied it was in the man’s best interests a colonoscopy, “at least”, should be done to get the necessary tissue for a histological diagnosis of the tumour, and he would make the orders sought. Any decision on surgery will be considered later.