Background
The HSE sought orders under the High Court’s inherent jurisdiction to permit removal of R.F.’s gastric band and related postoperative inpatient treatment. R.F., a woman in her thirties who lived and worked independently, opposed both the surgery and admission. She was represented by a court-appointed guardian ad litem, who obtained independent psychiatric and bariatric evidence.
Clinicians diagnosed R.F. with Other Specified Feeding or Eating Disorder. A recent barium swallow showed complete obstruction at the gastric band, with no contrast passing into the stomach after 11 minutes and marked oesophageal dilation. The evidence was that retaining the band created risks including malnutrition, permanent oesophageal dysfunction, gastric or oesophageal perforation, and potentially death. The proposed plan included laparoscopic band removal, postoperative care, and a period of specialised inpatient eating-disorder treatment.
The Court’s Holding
Mr Justice Barry O’Donnell held that R.F. lacked capacity to decide whether to accept or refuse the surgery and follow-on treatment. Although she could understand, retain and communicate information, the unanimous psychiatric evidence established that the psychopathology of her eating disorder prevented her from using or weighing the clinical evidence: her overwhelming fear of weight gain displaced the risks to her health and life.
The Court accepted the uncontradicted surgical evidence that removal, rather than mere deflation, was clinically necessary. It found the intervention proportionate despite its serious effect on R.F.’s autonomy, bodily integrity and short-term financial and employment concerns. The orders were granted, but removal to hospital and restraint were to be used only as a last resort, after efforts to secure her cooperation, and the proceedings would remain under close review.
Key Takeaways
- Capacity is decision-specific: a person may be articulate and independent yet lack capacity if illness prevents them from weighing relevant information.
- A finding of incapacity does not itself justify treatment; the court must assess necessity, constitutional rights and proportionality.
- Clear wishes opposing treatment carry considerable weight, but may be overridden where necessary to avert grave and otherwise unaddressable health risks.
Why It Matters
The decision illustrates the High Court’s careful use of inherent jurisdiction in urgent treatment cases involving adults with eating disorders. It confirms that compelled treatment requires robust expert evidence, a genuine assessment of less intrusive alternatives, and safeguards limiting coercion to what is necessary and proportionate.
The Court also stressed that its orders were not open-ended: continued intervention depends on the persistence of incapacity and proportionality.