Judge makes order to permit doctors carry out mastectomy

A judge has made orders permitting doctors to carry out a mastectomy within days on an intellectually disabled woman.

The orders were based on evidence she lacks capacity to understand she has breast cancer or the consequences of failure to treat it.

The woman, aged in her seventies, has been in residential care for some years and has been diagnosed with schizophrenia and intellectual disability. No active symptoms of psychosis are present in her case, the court heard.

The HSE, on foot of evidence of three doctors and supported by members of the woman's family and her court appointed guardian, applied on Thursday to the president of the High Court for orders permitting the surgery be carried out shortly.

The application was made to Mr Justice Peter Kelly in the context of an intended application to have the woman made a ward of court.

Paul Brady, for the HSE, said the unanimous view of three medical practitioners involved in the woman’s care and treatment is that she lacks the necessary mental capacity to understand the seriousness of her condition and make appropriate decisions on treatment.

The doctors, including the woman’s treating psychiatrist, said she does not appear to understand she is at risk if she does not undergo treatment, he said.

The woman had maintained there is nothing wrong with her breast, the court was told.

Curable

A number of treatment options were available but the view is that, if the optimal treatment of a mastectomy is provided, her breast cancer is curable and she will be able to maintain her existing good quality of life, counsel said.

The doctors’ considered she is a good candidate for the proposed surgery and other treatment options were problematic and not appropriate for her.

The medical view was that, if the recommended surgery is not carried out, her cancer will upstage and, while it would not shorten her life, it would adversely affect its quality.

The woman has no medical conditions such as to render the surgery high risk, the court was told.

The woman’s court appointed guardian said she has a good quality of life in her residence and he was anxious that is maintained.

While she is a pleasant woman, she appears to lack awareness of and insight into the seriousness of her condition and he supported the treatment proposal, he said.

In his ruling, Mr Justice Kelly said all the evidence is that the woman lacks capacity to understand her diagnosis and to consent for herself to the treatment.

In the circumstances, it was appropriate the court should act in her best interests and he was satisfied her best interests requires she gets the recommended optimal treatment.

He made orders permitting the treatment to be carried out, plus all necessary ancillary orders.

The court heard arrangements are in place for nurses at the woman’s residential facility to liaise with hospital staff to ensure careful and sensitive management of the woman after the surgery is carried out.