Young woman with anorexia must be tube fed, court hears

A Dublin hospital treats about 14 patients each year for severe anorexia nervosa, the High Court has heard.

The president of the High Court, Mr Justice Peter Kelly, was informed of the numbers as he continued orders allowing the hospital to tube feed a severely malnourished young woman who, he said, remains "critically ill" due to this "accursed disease".

This is a “very sad” case of an “intelligent” young woman with no understanding of the fact she is critically and profoundly ill, he said. That raised issues about her capacity and had lead to the court’s wardship jurisdiction being invoked.

He considered the feeding orders are crucial to her proper treatment and adjourned the case to March. While noting the medical evidence was the woman’s capacity is impaired, he also directed an independent medical visitor to assess the woman’s capacity.

A student aged in her 20s, the woman has had three in-patient hospital admissions so far due to anorexia, including in a specialist eating disorder unit in the UK. The longest admission was for nine months.

The latest admission began in November but, because she failed to make progress and her condition deteriorated to a point where doctors considered her life was at serious risk, the HSE got court orders earlier this month allowing for tube feeding and any other treatment necessary to sustain life.

When the orders were granted, the woman weighed 36.4kg and had a Body Mass Index of 12.

When the case returned before Mr Justice Kelly on Monday, he continued the orders, including ones permitting the woman be fed via naso gastric tube and, if she refuses that, for her to be appropriately restrained so such feeding can occur.

He hoped there would be no need for such restraint.

The woman’s mother, who was in court, said she supported the treatment regime.

In evidence, a consultant psychiatrist treating the woman said the orders had been and remained necessary for a further minimum period of four to eight weeks. On foot of the orders, the tube was inserted after discussion with the woman and with some co-operation on her part, the psychiatrist said.

She took the view the woman lacks capacity on the basis of her inability to believe she is at risk of dying due to severe malnutrition. The woman had said she does not want to die and maintained the naso gastric feeding was unnecessary but the medical team considered it was necessary following a “drastic reduction” in her weight during December.

When the orders were sought, there were three life threatening components of the woman’s condition, including low blood sugar and a cardiac condition.

While the hospital is not a specialist eating disorders unit, it has substantial experience dealing with anorexia with an average of 14 serious cases a year, the psychiatrist said. This was the first time the hospital had to get court orders to progress a patient and the aim was to stabilise the woman so she could get appropriate eating disorder treatment.

She agreed with the judge that, at one in five, anorexia has the highest mortality rate over a lifetime of any psychiatric disorder.

Sarah McKechnie BL, for the woman, said her client does not agree with the orders but saw the logic of them as she had failed to meet nutritional targets. The woman disliked the feeding tube and found it uncomfortable, she added.