The High Court has permitted doctors to take a blood sample from a 15-year-old girl detained for psychiatric treatment at Merlin Park Hospital in Galway, finding that the procedure was necessary for her treatment and welfare despite her refusal.
The minor, identified only as X.Y., had been diagnosed with bipolar affective disorder and was detained in the Child and Adolescent Mental Health inpatient unit under section 25 of the Mental Health Act 2001. Her detention had been extended by the District Court and was not challenged in these proceedings.
The court was told that X.Y. had a history of suicide attempts and remained a significant suicide risk. She was being treated with olanzapine, a mood-stabilising medication. Doctors wanted a blood sample both to investigate physical symptoms and to monitor possible adverse effects of the medication, including the potentially life-threatening condition neuroleptic malignant syndrome.
X.Y. opposed the blood test. Mr Justice Birmingham accepted that taking blood, particularly if restraint was required, represented a significant interference with bodily integrity and autonomy.
However, the judge found that she lacked capacity to refuse this particular procedure. Medical evidence indicated that while she understood why a test might be performed and what it involved, her judgment was impaired by her mental state and continuing wish to die. The court stressed that this did not mean all 15-year-olds, or X.Y. in relation to every medical decision, lacked capacity.
The judge adopted a broad interpretation of "treatment" under the Mental Health Act. He held that blood monitoring could lawfully form part of treatment where it was ancillary to the safe administration of psychiatric medication.
Both of X.Y.'s parents supported the proposed treatment. Independent psychiatrists consulted by her legal team also regarded olanzapine as appropriate and identified the need for medical monitoring.
The court concluded that permitting the blood test was proportionate and in X.Y.'s best interests. The exact form of the order, and related proposals concerning an ECG, x-ray or ultrasound, were left for further discussion with counsel.