Woman with anorexia will probably die without nasal-gastric feeding, court hears

A severely anorexic woman who “as a matter of probability will die” without nasal-gastric (NG) feeding and restrictions on her autonomy, has told the High Court she feels she has “lost control” of her life and wants “to find me again”.
The woman, who is in her 50s and has a long-standing diagnosis of anorexia, addressed the court by video-link from her hospital bed.
At a vacation sitting on Wednesday, Mr Justice Mark Heslin granted an application by the HSE for orders continuing previous orders for treatment necessary to protect the woman’s right to life and to bodily integrity.
The court heard the woman, who cannot be identified for legal reasons, is an involuntary patient in a department of psychiatry in a certain hospital, pursuant to the Mental Health Act 2001. On admission to hospital in July, her weight was 36kg and she had a body mass index of 14 – considered “dangerously low in cases of anorexia nervosa” according to the World Health Organisation, the court heard.
Originally an application was made to the High Court on an ex-parte basis (with just one party represented) on July 24th for emergency orders permitting treatment including NG feeding and “elements trespassing on her autonomy”, including monitoring for purging, restrictions on movement to prevent “micro exercising” and on fluid intake.
These orders were confirmed at a full hearing on July 31st.
On Wednesday Donal McGuinness, BL for the HSE, said the woman’s health remained “in serious jeopardy”. He said her BMI remained at 14 and her weight under 36kg. She was resisting elements of treatment.
“If the court doesn’t grant the orders then unfortunately [the woman] is unlikely to receive the nutrition she requires and the medical evidence is that her life will be in immediate danger. As a matter of probability, she will die,” he said.
Emma Slattery, BL for the woman’s Guardian ad Litem, submitted a report from a psychiatrist independent of the HSE, who found the woman was “terrified of eating”, “lacked insight” into her illness, and they had “no alternative but to support the orders sought by the HSE”.
Mr Justice Heslin said the woman was “the most important” person in his court. Asking her of her views on the orders sought, she said: “I don’t want to die … I don’t know what else I can say, judge. I appreciate everybody’s help and I want to find me again, not the anorexic me.” She asked for an “end date” to be put on the orders.
“I feel I am taking up a bed that is needed by somebody more sicker than me. I don’t think I deserve it. I miss my family, and I miss my dog, and I miss my life. I am crying out for help.”
Granting the orders Mr Justice Heslin said “no one was more deserving” of the bed than the woman. He thanked her for her contribution to the court “made with such clarity”. He said restrictions on her autonomy should “never go any further than is necessary to deliver effective treatment” and as soon as the woman’s capacity was “recovered”, the orders should be lessened.