Woman (18) with chronic anorexia can be restrained to be tube fed, High Court directs

A young woman with chronic anorexia who is “very close to death” may be restrained to be tube fed in order to save her life, the High Court has directed.

The 18-year-old woman had initially consented to naso-gastric tube feeding on her admission to hospital last February but has sabotaged it several times, has lost weight and is ”very close to death”, Patricia Hill BL, for the HSE, said on Friday.

Seeking various orders including allowing for tube feeding under restraint, Ms Hill said this was very much a “last resort” application, made in the context of intended wardship proceedings.

The woman was admitted to hospital in February under the Mental Health Act but has actually lost weight since for reasons including that she pulled out the tube several times and makes herself vomit, counsel outlined.

She has lost six kilogrammes in weight since admission, her BMI is now 12.9 and doctors believe it may be necessary to administer restraint to ensure tube feeding is effective.

Doctors consider the restraint option may in fact be less traumatic for the woman than the need to reinstate the feeding tube after she dislodges it, counsel outlined.

High Court president Ms Justice Mary Irvine said the woman is very close to death but has no insight into how dangerous her situation is.

The detailed evidence before the court made clear the woman was intent on sabotaging efforts to stabilise her condition, the judge said. The judge stressed she was not being critical of the woman, who lacked capacity as a result of anorexia to understand the reality of her situation.

She agreed to make the orders sought, including permitting the hospital to restrain the woman, in line with applicable protocols, for the purposes of tube feeding. She also appointed a guardian ad litem to represent the woman’s interests.

In a separate case, involving a woman with anorexia and a personality disorder, the judge was told this woman, aged in 30s, has made progress since naso-gastric feeding was administered.

However, the woman continues to lack insight into the severity of her condition and is likely to require a prolonged period of care to address mental health issues, Ms Hill said.

In that case, the judge continued orders permitting doctors to administer such treatment as they considered appropriate, including naso-gastric feeding if necessary.