Anorexic woman can be fed against wishes, court rules

A young woman weighing about 27kg and at "grave risk" of malnutrition and irreversible liver injury due to severe anorexia nervosa is to be fed through a nasogastric tube against her wishes, the High Court has ruled.

Doctors treating the 26-year-old woman, who has suffered from eating disorders since aged 12, believe the feeding treatment is vital to safeguard her life and health and to ensure she is taken out of “grave danger”, the President of the High Court was told.

As a result of her anorexia, her treating psychiatrist believes she does not have the necessary mental capacity to recognise the seriousness of the position and make appropriate decisions.

She did not accept she would die if she refused further nutrition leading to weight restoration, insisted she did not need to gain further weight and that doctors were trying to overfeed her, the court heard.

She has already suffered liver function abnormalities and her weight had dropped to as low as 24.2kg. While now taking in about 800-900 calories a day, she needs an intake of between 1,600 to 1,800 to achieve weight gain, one of her treating doctors said.

She would have to reach a weight of 31kg and a Body Mass Index of more than 13 as a first step towards taking her out of a medical danger zone, he said. Her BMI on May 19th last was 10.59. While there had been a slight weight gain to about 27kg, strategies could be employed to achieve that, including fluid intake, he indicated.

He considered this case was “at the most severe end” of the scale on anorexia nervosa and other feeding options suggested by the woman, including oral supplements and peg feeding, would not work.

Prior to her hospitalisation in late April as an involuntary patient under the Mental Health Act because of treatment refusal and dangerously low weight, she was losing weight at the rate of one kilo a week, Sara McKechnie BL, for the HSE told the court.

This application was being made because it was considered in the woman’s best interests, the woman having had access to all the treatment options available, including in the UK, but “nothing had worked”. Her parents have always been actively involved with her and supported the application.

While a nasogastric tube had been inserted previously, she had ripped it out, counsel added. Her doctors had told her on May 19th last, unless she complied with an oral supplements re-feeding plan delivering 1,800 calories daily, they would apply to the High Court for tube feeding. She had reluctantly agreed but a review on May 23rd indicated she had not complied fully.

Mr Justice Nicholas Kearns said this sadly was not the first such case to come before him and, given the evidence, he would make the orders sought. The matter would be subject to regular review, he added and returned it to June 5th.

The orders allow for tube feeding of the woman and whatever other medical procedures are deemed necessary, including the placing of “mittens” on her hands to prevent her pulling out the tube.

The judge had earlier asked the girl’s father about his views and was told the father and mother supported the HSE’s application. His daughter opposed the application and believed she could address the concerns by taking oral supplements but he and his wife shared the doctors’ view that would not work, the father said.

The father added he believed regular reviews would help his daughter as it would give her something to aim towards.

John Lucey SC, acting for a solicitor appointed to represent the woman’s views in the context of the HSE’s argument she lacked sufficient capacity, said she was opposed to the feeding treatment proposed and believed she should be able to survive by taking supplements orally. He asked for the matter to be listed again on June 5th to allow for review by another psychiatrist.