Court rules on care of woman with anorexia and diabetes due to lack of mental capacity

High Court reporters

A young woman with anorexia nervosa and diabetes can be detained in hospital and tube fed if necessary due to her lack of mental capacity to understand the danger to her life from her conditions, the High Court has ruled.

High Court President Mr Justice David Barniville granted the orders to the HSE.

A treating psychiatrist told the court of the woman's refusal to accept her doctors' advice regarding the risk involved by self-treating her diabetes with insulin while not eating properly.

The court heard the woman suffered from anorexia and type one diabetes, and was admitted to hospital last September where she remained until February and then received care on an outpatient basis.

She was readmitted in recent weeks due to concerns about a three stone weight loss and the way she was using insulin.

She is now in a general medical ward because needs intravenous dextrose and will have to remain there for a number of weeks until her condition is stabilised.

Her psychiatrist said he had carried out an assessment of the patient's mental capacity, and while she did not disclose any thoughts of self harm, she was in a state of hopelessness and did not believe her condition was serious enough to warrant treatment and did not accept she needed to be in hospital.

Her endocrinologist, who manages her diabetes treatment, shared the psychiatrist's concerns, the court also heard.

She had been asked if she wanted to participate in the court hearing but declined, her psychiatrist also said.

Mental capacity

Ruling that he must accept the doctors' evidence at this point, Mr Justice Barniville said her psychiatrist found her lack of mental capacity was partly due to her anorexia and partly due to a very low food intake and weight loss.

As there was a high risk that this could affect her brain and lead to a fatal outcome, a plan was required in which she would take part in a careful nutritional regime with three meals a day and, if necessary, Nasogastric-tube feeding.

The judge said the woman will also require 24-hour nursing care which may require restraint, which should be as minimal as possible.

She will also need to spend at least three weeks in a medical ward before being moved to a psychiatric ward, he said.

The judge was satisfied the orders were necessary and appropriate in her best interests and to preserve her life. He also appointed a solicitor as a court-appointed guardian.

The case comes back before the court in April.