The High Court has set aside orders permitting forcible tube feeding or any coercive treatment measures for a chronically anorexic young woman described as having a “very poor” prognosis.
She weighs about 25kgs with a BMI of 10.3, her lowest ever.
Mr Justice Mark Heslin on Wednesday granted a HSE application to set aside the orders on foot of unanimous views of several medical professionals that coercive measures, especially tube feeding, are not in the woman’s best interests, will not change the trajectory of her illness and are against their ethical and medical judgment.
In his ruling, the judge noted a range of treatments remain open to the woman, on condition she voluntary agrees to those, and a palliative care approach is favoured in her case.
Burden of coercive measures
Having examined the evidence and case law, he ruled the approach proposed by the doctors is lawful and the court should not intervene.
The doctors, including eating disorder specialists, considered the burden of the coercive measures on the woman outweighed the benefits. They said that was due to her very poor prognosis as a result of lack of engagement over years with therapies for her anorexia, her firm opposition to tube feeding and its physical and psychological impact on her when she underwent it in the UK.
Mental health issues
Aged in her late twenties, she has had hospital admissions for mental health issues since 2013, was diagnosed with anorexia some years ago and has received treatment in specialist eating disorder units here and in the UK.
She was made a ward of court in 2019 based on medical evidence she lacked capacity, due to anorexia, to make decisions about her medical treatment..
Her treating doctor in the UK said she acquiesced in naso-gastric tube feeding while there between 2019 and 2020, as a result of which she achieved some weight restoration. The woman has since said she acquiesced so she would get home to Ireland, remains traumatised by the tube feeding and will strongly resist any effort to re-introduce it.
Feeling of losing control
Her objections centred on her feeling of losing control over what nutrition is entering her body and on the physical and psychological impact on her, the court was told.
While able to develop relationships with therapists, the woman’s consistent focus was on the “here and now” rather than actively engaging in therapy to explore triggers of her anorexia and how to address those into the future, the doctor said.
The doctor said a palliative care approach had benefitted some anorexic patients in the UK but others had died. She did not believe readmission to the UK unit would achieve any real benefit in this case, saying the woman has shown a pattern of “steady decline” over years.
The woman was discharged back home to Ireland last year and her weight and BMI have fallen further.
Earlier, Paul Brady BL, for the HSE, said its application was not about “giving up” on the woman and the intention was rather to have doctors step back and permit her an opportunity to take control of her fate.
Palliative care
A palliative care approach did not mean end of life and the effect of professionals stepping back can mean life is preserved, albeit the woman is “very compromised”.
Conor Dignam SC, for the committee representing the woman’s interests, referred to reports where the woman said she would strongly resist naso-gastric feeding adding: “If I die, so be it.”
The reports showed she suffers from a “very entrenched” eating disorder but had made a very strong and clear statement she is doing her very best and wanted the court to be aware of that.
“I am eating every day and trying very hard,” she had said. She also said she feels very isolated and believes she is not getting adequate help for her disorder.
