Woman with anorexia can be tube fed due to lack of mental capacity, judge rules

A young woman with anorexia nervosa and diabetes can be detained in hospital and tube fed if necessary because of her lack of mental capacity to understand the danger to her life from her conditions, the president of the High Court has ruled. 

 

Mr Justice David Barniville granted the orders to the Health Service Executive (HSE) after the woman’s treating psychiatrist told of her refusal to accept her doctors’ advice of the risk involved by self-treating her diabetes with insulin while not eating properly. 

 

The court heard the woman suffered from anorexia and type one diabetes and was admitted to hospital last September, where she remained until February and then received care on an outpatient basis. She was readmitted in recent weeks due to concerns about a three-stone weight loss and the way she was using insulin. 

 

She is now in a general medical ward because she needs intravenous dextrose and will have to remain there for a number of weeks until her condition stabilises. 

 

Her psychiatrist said he carried out an assessment of her mental capacity. While she did not disclose any thoughts of self-harm, she was in a state of hopelessness and did not believe her condition was serious enough to warrant treatment and did not accept she needed to be in hospital. 

 

Her endocrinologist, who manages her diabetes treatment, shared the psychiatrist’s concerns, the court heard. 

 

Declined to participate 

The woman was asked if she wanted to participate in the court hearing but declined, the psychiatrist added. 

 

Ruling that he must accept the doctors’ evidence at this point, Mr Justice Barniville said the psychiatrist found the woman’s lack of mental capacity was partly due to her anorexia and partly due to a very low food intake and weight loss. 

 

As there was a high risk that this could affect her brain and lead to a fatal outcome, a plan was required in which she took part in a careful nutritional regime with three meals a day and, if necessary, nasogastric tube feeding. The judge said she will also require 24-hour nursing care which may require restraint, which should be as minimal as possible. 

 

She will need to spend at least three weeks in a medical ward before being moved to a psychiatric ward, he said. 

 

The judge was satisfied the orders were necessary and appropriate in her best interests and to preserve her life. 

 

He also appointed a solicitor as a guardian. The case comes back to court in April. 

 

The Irish Times