Anorexic woman can be tube fed against her wishes to avoid ‘potentially fatal’ outcome

A High Court judge has made orders permitting a young woman with severe anorexia to be tube fed against her wishes after being told doctors fear a “potentially fatal” outcome if that does not occur.

The now 18-year old has received treatment for anorexia for years and was made an adult ward of court last autumn based on medical evidence that due to the impact of anorexia, she lacked capacity to make decisions concerning her treatment.

Mr Justice Mark Heslin was told on Tuesday by Paul Brady BL, for the HSE, that the woman had been living at home with her parents and was under the care of a doctor there. Her situation deteriorated last month to the point where she was moved to a psychiatric hospital and later to a regional hospital due to her declining weight and Body Mass Index (BMI).

Because she refused feeding and the regional hospital lacks facilities to administer naso-gastric feeding without a patient’s consent, she was admitted on an emergency basis in recent days to another hospital.

Her treating team believe that if she continues to refuse naso-gastric feeding, her situation will continue to deteriorate with a “potentially fatal” outcome, Mr Brady said. The medical view was that she does not appreciate the severity of her condition and lacks capacity to weigh the risks and benefits of treatment.

Triggered

The deteriorating situation triggered the re-listing of the woman’s case before the court and permission was being sought for orders including permitting naso-gastric feeding to be carried out with restraints if necessary, Mr Brady said.

An independent solicitor who spoke by phone to the woman earlier on Tuesday told the judge she sounded “quite low”, did not wish to discuss eating and opposed naso-gastric feeding orders. Her opposition was more matter of fact than “unpleasant”, he said.

The judge heard the woman’s parents support the orders but have concerns they are being excluded from consideration about her care and treatment and wished to see medical reports concerning her.

Mr Brady said there was no intention to sideline the parents but the HSE had to take into account the woman is an adult and the necessity of building a therapeutic relationship between her and clinicians in relation to her treatment.

Immediate priority

The immediate priority was to address the urgent situation presenting and access to reports could be addressed later after the woman’s views on that were obtained, he said.

Natalie McDonnell BL, for Patricia Hickey, the general solicitor for wards of court, said that having taken into account the woman’s views and the medical evidence, including concerns over her lack of capacity, her side supported the orders as necessary to protect the woman’s right to life and in her best interests.

Having heard the sides, Mr Justice Heslin said he would make the various orders sought, including permitting naso-gastric feeding and for early review of the situation next month.

He agreed the parents’ access to their daughter’s medical reports could be decided once the woman’s views on that issue are established.