Judge warns of danger to vulnerable woman if she is not made ward of court

The president of the High Court has said he has “very little doubt” he would be signing a vulnerable young woman’s “death warrant” if he does not make her a ward of court, based on a medical visitor’s report that she is not of unsound mind.

Mr Justice Peter Kelly has directed a second report from another medical visitor because of concern, based on other evidence from her treating clinician and her own behaviour including “chronic” self-harming, that the woman is not of sound mind. Her right to life must be “fully respected and vindicated”, he said.

The 18-year-old woman, who has limited family support, has been diagnosed with an emotionally unstable personality disorder (EUPD), is seriously underweight, has expressed a clear wish to take her own life and has a history of serious self harm over years, including cutting and attempting to choke herself.

The HSE initiated an application to have her made a ward of court following a recent incident where she was admitted to a hospital’s intensive care unit for reasons including overdose of a prescription drug and serious concerns about her very low body weight and Body Mass Index.

As part of the wardship application, Mr Justice Kelly asked an independent medical visitor to assess whether the young woman, who is deemed not mentally ill, has capacity to make decisions about her health and welfare.

When the matter was back before him on Tuesday, the judge said he had “serious misgivings” about the medical visitor’s conclusion the young woman did not meet the criteria for wardship in that she is not of unsound mind.

The visitor also considered the woman incapable of managing her person as of now due to impaired reasoning and that she would benefit from a particular therapy, the court heard.

The judge said he was not convinced the medical visitor had dealt with the matter in the context of a proposed wardship as the report seemed to have been written exclusively through the “prism” of the mental health legislation.

The Mental Health Act, unlike in the UK, excludes a personality disorder as a mental illness but a personality disorder can disapply a person’s capacity to make decisions in their own interests, he said.

He had very little doubt, if he did not take the woman into wardship, that would amount to “almost signing her death warrant” given her state of health and stated intent to self harm and take her own life.

She had said she wants to be able to make her own decisions concerning whether she will engage with services or not, wants to be left alone and wants to die, he noted. She had also said she considers treatment “pointless” and believes she does not deserve treatment and had engaged poorly with a refeeding progamme.

She had said she appreciated she might have died when taken into intensive care but had said that was okay because she wants to die.

In the circumstances, he was appointing a second medical visitor to assess the woman and, in the interim, would continue orders for her hospital detention and treatment, he said.

Paul Brady BL, for the HSE, and counsel for the woman’s court-appointed guardian both supported the judge in seeking the opinion of a second medical visitor.

Mr Brady said there is a disagreement between her treating clinician and the medical visitor’s report concerning the proper characterisation of what is or is not unsound mind. Her clinician considered EUPD does not fully explain her presentation and she may also have had an undiagnosed disorder for some time, he said.

The HSE shared the court’s view the medical visitor’s report did not involve a correct interpretation of how the wardship jurisdiction has operated for some time, counsel added.