The High Court has approved an order that Ms. A receive care and treatment for her severe, long-standing anorexia only when her treating clinicians consider it in her best interests and she agrees to accept it. The order means there will be no further coercive treatment for her eating disorder, including compulsory admission or naso-gastric feeding.
In a judgment delivered on 20 December 2021, Ms. Justice Niamh Hyland said Ms. A’s health was “very precarious” and that she might die prematurely if coercive treatment was not provided. But the judge concluded that coercive treatment was unlikely to bring lasting benefit, could be traumatic and carried medical risks given Ms. A’s frailty. She found that continuing it was not in Ms. A’s best interests.
The HSE sought the order at a review of Ms. A’s wardship. The medical evidence before the court described ongoing malnutrition and serious health effects, including low sodium and intermittent low blood sugar. Doctors said Ms. A’s adherence to treatment recommendations was impaired and that she had consistently refused further feeding by tube. They considered that she lacked capacity to refuse re-feeding because of her eating disorder, but said coercive treatment was unlikely to help her in the long term.
Ms. A had been made a ward of court in January 2020, after years of severe anorexia and acute medical episodes. Earlier court orders had allowed her detention and treatment, including compulsory feeding. In May 2021, after she was admitted involuntarily to a mental health unit and remained deeply distressed, the court removed the power to admit or detain her against her wishes. She later returned to hospital voluntarily.
The judge said the current application differed from those earlier orders because the evidence now raised the prospect that, if Ms. A refused treatment, life-saving care might not be given. She considered the presumption in favour of protecting life alongside Ms. A’s bodily integrity, autonomy, privacy and dignity, her persistent opposition to coercion, the medical opinions and the likely effects of coercive treatment. No party opposed the HSE’s proposed approach. Ms. A’s husband was not at the hearing and, through information relayed to the court, was not proposing an alternative approach.
The order does not declare that Ms. A has capacity to consent to treatment. The judge expressly found that she continues to lack capacity. Her agreement is relevant because the order recognises the effect of imposing treatment against her wishes. Clinicians may decide what treatment to offer without returning to court for approval, but it must meet the order’s best-interests and agreement conditions. The judgment said the order does not remove the risks to Ms. A’s life, given her fragile health.