A psychiatrically ill teenager who told doctors she wanted to kill herself before her sixteenth birthday is to have blood samples taken from her against her wishes following a High Court order.
Doctors want to take blood samples to establish if the 15-year-old girl has a life-threatening physical disorder known as neuroleptic malignant syndrome (NMS) and to ensure a drug being administered is not causing her to develop diabetes.
The girl, who cannot be named by court order, has bipolar affective disorder and was detained last October in an adolescent mental health inpatient unit under the Mental Health Act 2001. Her detention follows other admissions in 2012 and 2011 after she made attempts to take her own life and has been extended by District Court order to the end of this month.
The case involved consideration of issues including the definition of medical "treatment" under the 2001 Act and in what circumstances such treatment may be lawfully administered to minors detained under Section 25 of that Act which provides the HSE can apply to the District Court for detention of young people considered psychiatrically ill.
Mr Justice George Birmingham accepted the girl is a serious suicide risk who had not challenged her detention in an adolescent mental health inpatient unit for the purpose of "treatment".
While Section 25 authorised doctors to treat a child, they could not, for example, administer psycho-surgery or electroconvulsive therapy to children without court approval. Administration of long term medication beyond a three month period must also be authorised by two consultant psychiatrists.
In this case, the girl opposed the taking of blood samples but doctors considered those necessary to monitor her reaction to her medication, a mood-altering drug, olanzapine which, the judge noted, is known to be associated with a possible risk of developing diabetes. The girl's parents also supported taking the samples.
Reports from two psychiatrists engaged by lawyers appointed to represent the girl also supported the view she is a significant suicide risk and her current treatment with olanzapine - which she had resisted taking - is appropriate. One doctor believed the girl might have symptoms of NMS but a diagnosis could only be made on foot of blood tests.
In the circumstances, the judge found the taking of a blood sample was in her "best interests" - the principle consideration under Section 4 of the Act - and a proportionate measure designed to protect her life and well-being. She was "a serious suicide risk" and that risk was heightened in the lead up to her 16th birthday, he said.
A blood sample was also necessary if the olanzapine was to be administered in accordance with best practice and to enable a definite diagnosis in relation to NMS. It was "devoutly to be hoped" the blood tests would exclude that.
A purposive interpretation of the meaning of "treatment" in the Act encompassed taking blood samples for the purposes of blood monitoring and regarding taking a blood sample as linked to, or ancillary to, the administration of prescribed medication - olanzapone - for purposes of ameliorating a mental disorder.
The judge found the girl lacked the necessary mental capacity to refuse consent to the taking of blood samples. While a doctor believed the girl's refusal could be linked with her wish to die, that same doctor believed her real belief was she would not die from an infection because she believed that "only happens to old people", the judge noted.
The judge stressed the girl's capacity to make medical decisions may fluctuate and he was not laying down a general principle 15 or 16 year-olds should always be regarded as lacking capacity.
Because the forcible taking of a blood sample involved a significant interference with the autonomy and bodily integrity of the girl, and in circumstances where other treatments were and may still be sought, the HSE initiated proceedings and lawyers were appointed to represent her views.
