HSE not to seek contraceptive implants for mentally ill woman

The HSE has decided against seeking High Court orders allowing doctors administer long-term contraceptive implants to a heavily pregnant mentally ill woman.

The HSE indicated last week it might seek orders allowing implants be administered when a scheduled Caesarean section procedure is being performed on the young woman.

She has a history of mental illness over some years and was sexually abused in the past.

Because she has not engaged with a medical team about a delivery plan and due to concerns for the welfare of herself and her baby, the court has made orders allowing doctors perform a scheduled C-section and other measures necessary for a safe delivery.

The President of the High Court, Mr Justice Peter Kelly, said last week any application for contraceptive implants would have to be based on evidence and he considered it a "step too far" at this stage.

His immediate concern was the welfare of the woman, a ward of court, and her unborn baby, he said.

On Monday, when the case returned before the judge, David Leahy BL, for the HSE, said it would not be applying to have implants administered around the time of the C-section.

The HSE always recognised any such application would have to be made on evidence, the intention last week was to flag the possibility of it and the matter was not being proceeded with now, counsel said.

Interim care order

The judge was also told, based on reports and assessments of the woman and the child’s father, Tusla, the Child and Family Agency, will seek an interim care order for the baby just a few days after birth.

Tusla’s application to the District Court will be made on notice to the baby’s mother and father and the General Solicitor for Minors and Wards of Court, representing the interests of the woman.

Because Tusla considers the statutory route the most appropriate, the judge said he was not required to consider whether the child should also be made a ward of court.

The reports and assessments concerning the parents were comprehensive and made “grim reading”, he said. They showed the father also had psychiatric and other difficulties.

Counsel for the general solicitor said she was very anxious that the woman, subject to risk assessment, had an opportunity to bond with the baby after birth. The reports appeared to not really set out an assessment of an eventuality where it might be possible to keep mother and child together, she said.

Counsel for Tusla said a comprehensive child protection plan was in place, and a contact plan aimed at fostering attachment between the child and parents was to be worked out.

The judge said all such issues could be addressed by the District Court and the medical and psychiatric team involved, and he was sure the matter would be handled sensitively.

Care after birth

The High Court could not micromanage a situation that could alter at short notice, and his concern in relation to the child was to ensure no vacuum concerning care after birth.

Addressing the woman’s situation, the judge continued orders permitting an elective C-section and associated necessary treatments and investigations.

Expressing hope all would go well for mother and baby at the birth, he also made orders to address the woman’s postnatal physical and psychiatric care.

Described as frail, the woman, who cannot be identified by court order, is not communicating and had been refusing to eat and take necessary fluids. She was hospitalised in recent months due to intensifying concerns for herself and her unborn who, according to scans, appeared to be developing normally.

The court heard her responses to the pregnancy had been inconsistent and a consultant psychiatrist considered the deterioration in her mental condition was attributable to the pregnancy.