The High Court declared that a prisoner identified as P McD had validly refused medical and nutritional assistance during a hunger strike, and that his direction should remain operative if he later became incapable of making treatment decisions. The court also declared that the prison governor could give effect to his wishes not to be fed or receive medical assistance.
The judgment followed a plenary hearing on the Governor of X Prison’s application for guidance about McD’s capacity and the prison’s obligations. Justice Baker heard oral evidence from McD and two psychiatrists. She found that he understood the consequences and alternatives, and that his decision-making capacity was not undermined by his isolation, bereavements or personality traits. The judgment records that McD understood his hunger strike could lead to death, although he did not wish to die.
McD began refusing food on 8 February 2015, initially as a protest about exercise arrangements and the delivery of meals. He said he feared abuse and contamination by other prisoners. Those were his stated concerns; the court did not determine the separate prison-conditions complaints in this proceeding. Baker said McD understood that the court was not being asked to change his conditions.
The court held that a competent adult may refuse treatment, even where refusal may lead to death, and that the State’s duty to protect life did not require overriding McD’s freely made choice. It found that his decision also covered treatment if he became incapacitated and fell into a coma. The declarations addressed his refusal of medical and nutritional assistance; they did not order changes to prison conditions.
On the third day of the hearing, McD gave fresh instructions to seek separate relief concerning his prison conditions. He agreed to take a hospital bed and receive intravenous medication and liquid nutrition, but no solid food, while those proceedings were pursued. Baker said the judgment reflected the evidence and questions before her, and that circumstances might change the ultimate outcome.