The High Court has found that R., an anonymised young man with complex needs, had capacity to consent to treatment after his return to Ireland from a secure hospital in England. The court said it would hear further submissions on the form of any order required; it did not make a final order in the judgment.
R. had been placed at St. Andrew’s Psychiatric Hospital in Northampton by court order in June 2014, initially as a minor. After he turned 18, the High Court continued detention orders under its inherent jurisdiction. In May 2016, the court discharged those orders from midnight on 31 May, allowing R. to move voluntarily to a Nua Healthcare facility in Edenderry.
The court said R. had received little therapeutic benefit on the Fairburn Ward, where he was placed for his safety after difficulties on an adult ward. A place in a more suitable low-secure ward was unavailable. The judge concluded that his detention was no longer justifiable because its therapeutic rationale had become highly questionable.
Doctors disagreed about R.’s capacity. Dr Robert Daly and Dr Garrett McDermott considered that he had capacity, with Dr Daly saying his decision-making had improved. Dr Andrew Iles, who treated R. in England, considered him unable to consent to his treatment. Dr Anthony Kearns had previously assessed R.’s capacity as fluctuating and potentially capable of improving with treatment.
The court accepted Dr Daly’s assessment. It said requiring a person to understand every subtle detail of treatment would set an impossibly high threshold, and that a person with capacity may make decisions others consider unwise. The court found R. had capacity, including from October 2015, and said personal autonomy meant the court could not limit the liberty of a person able to make decisions about his life within the law.
After the move to Ireland, R. was absent from Nua for significant periods and did not attend further capacity assessments. The court recorded that he appeared to be living in alternative accommodation and that support under the aftercare plan would be offered if requested. It said the case could not continue indefinitely, while noting that one final review might be needed to establish whether R. had taken up the Nua place. The judgment ended by directing that submissions be heard on the form of any order.