A young woman who suffers from the eating disorder anorexia nervosa and is refusing nutritional feeds in hospital is to be fed through a tube by order of the High Court.
The president of the High Court, Mr Justice Nicholas Kearns, said it was "a life or death" situation and he would grant the order sought by the HSE permitting the 23-year-old woman to be fed immediately, as her medical carers deem appropriate.
The judge said everybody was trying to do their best for the unfortunate woman whom, the court was told, will die if she does not get the treatment required.
The HSE’s application was supported by the woman’s parents, the judge was told. None of the parties can be identified by order of the court.
A consultant involved in treating the woman said she urgently requires medical intervention to safeguard her life, and the prognosis was so grave she would simply not survive much longer if her body does not get the nutrients it requires.
The woman had refused four out of seven oral nutritional supplements in the last 24 hours. Due to her low body weight, 32.8kg with a BMI of 12.2, she runs the risk of collapse, it was stated.
Her medical team believe she needs to restore some 7kg to allow her be sufficiently stable to function outside of the hospital.
The woman does not accept she will die if she refuses further nutrition leading to weight restoration, the court was told.
Peter Finlay SC, for the HSE, said the matter was urgent. The woman had had anorexia nervosa for 10 years and had been admitted to hospital three times, he said.
In an affidavit, a consultant physician in gastroenterology said the woman was first admitted to hospital in late 2012 as a result of starvation due to anorexia nervosa.
Upon admission, her body weight was 26kg and she had a BMI of 9.8. She had to be artificially ventilated and a gastrostomy PEG tube was inserted in order to feed her safely. When she regained consciousness, she was insistent she could maintain her weight and was eventually discharged home.
Unfortunately, there had been two readmissions of the woman since then which have lasted for several months and she has remained in hospital continuously since the middle of last year, the doctor said.
On her most recent admission, her weight had dropped to 21 kg. Her current situation is “extremely grave”, the doctor said.
Despite her actions to the contrary, the woman has expressly stated she does not wish to die and she has consented to all other medical treatment, the doctor added.
In an affidavit to the court, a consultant psychiatrist said the woman had previously agreed to take oral supplements but, after she restored some weight, she could no longer agree to a continuous plan of refeeding and began to refuse feeds. The multidisciplinary team looking after her believes she does want treatment but is unable to accept it due to the severity of her anorexia nervosa, the psychiatrist added.
Earlier, after Mr Finlay applied for the order, Michael Ramsey BL, for the woman, asked the court for a short adjournment to allow an independent psychiatric report on his client to be carried out.
Mr Justice Kearns said he would make the order sought by the HSE and, when the case returns before him next Tuesday, counsel’s application could be made then if required.