News Courts

Friday 22 August 2014

Anorexic woman who weighs four stone to be fed against her will

Tim Healy

Published 29/05/2014 | 02:30

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The Four Courts Dublin.
Pic Steve Humphreys
12th August 2013.
The Four Courts Dublin

A young woman weighing about 27kg (4.3 stone) due to severe anorexia nervosa is to be fed through a tube against her wishes, the High Court has ruled.

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The order also provides for the placing of "mittens" on her hands to prevent her pulling out the tube.

She was at "grave risk" of malnutrition and irreversible liver damage, the court was told.

Doctors treating the 26-year-old woman, who has suffered from eating disorders since the age of 12, believe the feeding treatment is vital to safeguard her life and health and to ensure she is taken out of "grave danger", the President of the High Court was told.

As a result of her anorexia, her treating psychiatrist believes she does not have the necessary mental capacity to recognise the seriousness of the position and make appropriate decisions.

The woman did not accept she would die if she refused further nutrition leading to weight restoration, insisted she did not need to gain further weight and believed doctors were trying to overfeed her, the court heard.

She has already suffered liver function abnormalities and her weight has dropped to as low as 24.2kg (3.8 stone).

While now taking in about 800-900 calories a day, she needs an intake of between 1,600 to 1,800 to achieve weight gain, one of her treating doctors said.

She would have to reach a weight of 31kg (4.9 stone) and a body mass index (BMI) of more than 13 as a first step towards taking her out of a medical danger zone, he said.

Strategies

Her BMI on May 19 last was 10.59. While there had been a slight weight gain to about 27kg, strategies could be employed to achieve that, including fluid intake, he indicated.

He considered this case was "at the most severe end" of the scale on anorexia nervosa and other feeding options suggested by the woman, including oral supplements and peg feeding, would not work.

Prior to her hospitalisation in late April as an involuntary patient under the Mental Health Act, she was losing weight at the rate of one kilo a week, said counsel for the HSE, which made the application to tube feed her.

Sara McKechnie BL said the application was being made because it was considered in the woman's best interests. She had had access to all the treatment options available, including in the UK, but "nothing had worked".

Her parents have always been actively involved with her and supported the application, Ms McKechnie said.

Mr Justice Nicholas Kearns said this sadly was not the first such case to come before him and, given the evidence, he would make the orders sought.

The matter would be subject to regular review, he said, and another psychiatrist is to assess the situation.

The orders allow for tube feeding of the woman and whatever other medical procedures are deemed necessary, including the placing of "mittens" on her hands to prevent her pulling out the tube.

The judge was told the father and mother supported the HSE's application.

Irish Independent

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