Judge permits kidney surgery on mentally ill man

A judge has made orders permitting urgent surgery to be performed on a mentally ill man to remove a cancerous tumour in one of his kidneys with a view to preventing it spreading.

The man, now aged in his 60s, has a long history of treatment-resistant chronic paranoid schizophrenia. He was diagnosed with that illness when aged 17 and has spent long periods, including the last 10 years, detained in psychiatric hospitals under orders made under the Mental Health Acts.

His case was brought by the HSE before the president of the High Court, Mr Justice Peter Kelly, on Wednesday in the context of concerns by his treating psychiatrist and consultant that he lacks the necessary mental capacity to consent to the surgery. The man was represented in court by his solicitor who shared the concerns about the man’s capacity.

The solicitor said he has represented the man before Mental Health Tribunals for some years and has seen no improvement in his condition. While the man had told him “I don’t want it” at a meeting this week where the solicitor explained the rationale for the surgery, much of what he said was incomprehensible and he appeared not to understand what he was being told, the solicitor said.

Appointment made

Paul Brady BL, for the HSE, said an appointment for the surgery had been made for early next month but, due to the man’s non-co-operation, a court-appointed medical visitor had been unable to assess his capacity for the purpose of determining if he should be made a ward of court.

Mr Justice Kelly said he was satisfied from “strong evidence” before him, including from the man’s treating psychiatrist and observations from the court medical visitor, the man is of unsound mind and lacks the necessary capacity to consent to the surgery. This situation needs to be addressed urgently as there were concerns, if it was not, the disease would spread, the judge said. The tumour was in one kidney while the other was healthy.

The evidence was the proposed surgery, for removal of the cancerous kidney, was standard surgery for this form of cancer and carried a low risk, he said. He would make the orders authorising the surgery early next month as he considered there was a “medical imperative” for it and “time is not on his side”.

Detected by scan

The judge noted the tumour had been detected by a scan carried out after the man was admitted to hospital for treatment for another condition. It appeared the tumour was localised but doctors were concerned, if surgery was not urgently performed to remove it, there was a risk it would spread, possibly leading to a terminal illness.

The judge also noted the man had walked out of meetings with his solicitor over the proposed surgery and also refused to let the court medical visitor assess him after expressing concern she was going to “shop him”. While the visitor was unable to assess him, she had observed there were many indicators to question his capacity.

The orders permit transfer of the man from the psychiatric hospital where he is now detained to another hospital where he will be detained for surgery and all necessary ancillary treatments.

They also permit gardaí to arrest and return him to either hospital should be abscond. The judge will review the situation later next month.