The High Court has authorised the transfer of a detained man to hospital or another suitable clinical setting for nourishment and medical care, finding that he lacked capacity to refuse food, fluids and treatment at the time of the ruling.
Mr Justice Heslin made the declarations and orders on 5 March 2025 at the ex parte stage, on an application by the governor of a prison. The orders allow necessary and proportionate steps to preserve the respondent’s life despite his expressed refusal of nourishment and treatment. They are to remain in force only as long as needed to protect and preserve his life, or until further order of the court.
The respondent was on remand under warrants relating to ongoing prosecutions. The court noted that prison policy respects a prisoner’s decision to refuse nourishment where the person has capacity to make that decision. The judge said the orders would significantly interfere with the respondent’s autonomy.
The evidence described two episodes of food and fluid refusal. After resuming nutrition and bringing an earlier application to an end on 24 February, the respondent began refusing again on 25 February. A doctor’s report dated 3 March said he was weak, had difficulty raising his head and needed immediate rehydration, with refeeding if the court found he lacked capacity. Medical staff later reported that he appeared emaciated and that his lack of engagement prevented clinical observations. The prison doctor said on the morning of the ruling that the respondent’s health had deteriorated overnight and he was at risk of sudden death.
The court considered differing clinical views. An independent forensic psychiatrist concluded that acute psychosis impaired the respondent’s ability to weigh information about refusing food and fluids. The judge gave that opinion greater weight, citing the psychiatrist’s specialist expertise, detailed assessment and consistency with other clinicians’ views. The court found that the respondent lacked capacity, on a functional assessment, to decide about refusing food, fluids or medication.
The judge said the prison service could not provide the physical healthcare required, and that the statutory route considered in the evidence was unavailable for those urgent needs because the designated mental health centre was not a general hospital. He found the application appropriate to protect the rights of a vulnerable person in State care.
The court also appointed a guardian ad litem, Ms Leahy, and directed that relevant parties, including the respondent and the HSE, be notified. The judge indicated that a return date should be set within days, allowing time for the guardian to meet the respondent and for transfer and necessary nutrition to take place. The ruling did not determine the ongoing criminal prosecutions.