Mentally ill woman can be given Caesarean, court rules

Doctors may take all necessary steps to safely deliver the baby of a mentally ill woman in an advanced stage of pregnancy, the High Court has ruled.

The orders, sought by the HSE, include some allowing doctors to carry out an emergency Caesarean section if need be. The HSE wants further orders permitting doctors to proceed, on a future date, with a scheduled C-section for the woman.

Due to significant concerns about her mental and physical health, including her ability to tolerate a normal vaginal delivery and associated necessary examinations, they consider that is necessary in the best interests of both the woman and baby.

The President of the High Court, Mr Justice Peter Kelly, said, based on the evidence, he was minded to make those additional orders but would decide after an inquiry next week as to whether the woman should be made a ward of court.

Taking a person into wardship requires the court to be satisfied, among other matters, that they lack the necessary mental capacity to make informed decisions about their financial and personal affairs, including medical treatment.

Pending that inquiry, the judge continued orders allowing an emergency C-section be carried out should the need arise. He also continued orders permitting doctors to carry out obstetric and other examinations and all necessary medical treatment and ancillary treatment, including tube feeding if necessary.

Refusing to eat

Described as physically frail and with a long history of mental illness, the woman, who cannot be identified by court order, is not communicating and had also been refusing to eat and drink. She was a victim of sexual abuse in the past.

The HSE brought the case before Mr Justice Kelly because the woman has been deemed by her treating doctors and psychiatrists as lacking the capacity to make informed decisions about her treatment.

Doctors say she has not responded to their efforts to engage about a delivery plan, has given no indication she understands the information presented to her and is also not communicating with her partner or others close to her.

She was hospitalised in recent months due to intensifying concerns about her physical and psychiatric state. That has contributed to concerns about her own health and that of her unborn child who, ultrasound scans show, appears to be developing normally.

While she had expressed a desire some months ago to continue with her pregnancy, her mental condition has deteriorated since and her responses to the pregnancy have been inconsistent.

Foetal heartbeat

She was described as apparently uninterested in the baby’s well-being while on other occasions was observed to be listening to the foetal heartbeat.

A consultant psychiatrist considered the deterioration in her mental condition was attributable to the pregnancy.

The judge was told by David Leahy BL, for the HSE, a court-appointed independent medical visitor who assessed the woman had, in a report, expressed the view she was of unsound mind and not capable of managing her affairs.

Counsel also said doctors wanted to carry out a C-section procedure by arrangement at a future specified date.

All the evidence would suggest the scheduled C-section should proceed and he was in a mind to do that unless there was an objection, Mr Justice Kelly said.

The woman was in a very suitable place of treatment as of now and was getting very good care, he added.