Malnourished woman at ‘high risk’ of death can be tube fed, judge rules

A High Court judge has made orders permitting urgent tube feeding and other treatment for a severely malnourished woman whose life is said to be “in acute danger”. 

 

In the absence of the treatment, the woman is at “high risk” of imminent death over the next week or two, her treating psychiatrist said. 

 

The woman lacks insight into the seriousness of her situation, she added. 

 

The orders were sought by the HSE and the application was supported by the woman’s family. 

 

Mr Justice Mark Heslin heard that the woman is aged in her 50s and has a serious health condition but is not complying with necessary medication to address that. Her eating disorder has been compounded by starvation over the past two weeks which, combined with her not taking medication for her health condition, has put her at risk of sudden death, the doctor said. 

 

The woman is in a state of delirium concerning time and place and her professional view is the woman lacks capacity to make decisions about her medical treatment, she added. 

 

Staff at the hospital where she is being treated have tried to build up trust with her and she agreed this week to take a cup of tea and it was hoped to build on that. Apart from the cup of tea, the woman had had no nutritional intake. 

 

The immediate need was to take steps to address the seriousness of her situation and to stabilise her, which will require naso gastric feeding to start within the next 24 hours, the doctor said. Given her level of malnutrition, it would take some weeks to stabilise her. 

 

Voluntarily 

While the hospital hopes the woman will voluntarily agree to feeding, it wanted the orders in the event she does not. As she may become distressed about feeding, it also wanted orders permitting it restrain and sedate her, according to the relevant protocols. 

 

Sarah McKechnie BL, for the HSE, applied ex parte on Wednesday, in the context of intended wardship proceedings, for a range of orders. 

 

A brother of the woman said he and other siblings were very concerned about their sister and supported the HSE application at this stage. The family has been troubled about the woman’s condition and has spent much time attempting to persuade her to eat, he said. 

 

In his ruling, Mr Justice Heslin noted that, on her admission to hospital some days ago, the woman said she should not be there and there was “nothing wrong with me”. 

 

She appeared bewildered, stressed, disoriented, was refusing food and fluids and had no insight into the severity of her condition. On a previous admission, she also refused treatment despite being very unwell on admission. 

 

Unsound mind 

The application for wardship was brought with a view to saving her life and her psychiatrist was of the view the woman is of unsound mind and lacks capacity to manage her person and affairs, the judge said. 

 

The current position is she is not eating and refusing to take her medication, both of which are life threatening, and her family are very concerned, he said. 

 

He was satisfied the court’s wardship jurisdiction is engaged and the orders sought were “entirely appropriate and necessary and very much in her best interests”. 

 

The judge made orders permitting treatment, appointed a guardian ad litem to represent the woman’s interests, directed an independent medical visitor to attend the woman for a capacity assessment and returned the matter to next month. 

 

The Irish Times