The HSE has got court orders permitting doctors to carry out a scheduled Caesarean section procedure on a mentally ill woman in an advanced stage of pregnancy.
The HSE also sought orders permitting doctors to administer contraceptive implants around the same time as the C-section procedure on grounds that was considered in her best interests.
However, the President of the High Court, Mr Justice Peter Kelly, told David Leahy BL, for the HSE, the implants application was premature, “a step too far” at this stage and would have to be grounded on appropriate evidence.
His immediate concern was the current situation as the pregnancy was coming to term, he said.
He made orders making the woman a ward of court and appointed the general solicitor of wards of court as her committee to represent her interests.
Described as physically frail and with a long history of mental illness, the woman, who cannot be identified by court order, is not communicating and had been refusing to eat and take necessary fluids. She was a victim of sexual abuse in the past.
She was hospitalised in recent months due to intensifying concerns about her physical and psychiatric state, her own health and that of her unborn who, according to ultra sound scans, appeared to be developing normally.
While she expressed a desire some months previously to continue with her pregnancy, her mental condition has deteriorated since and her responses to the pregnancy have been inconsistent. A consultant psychiatrist considered the deterioration in her mental condition was attributable to the pregnancy.
The general solicitor told the judge this week she is awaiting a care plan for the woman from the HSE and had no objection to the orders as the medical evidence was “clear and reasoned” and included a report of an independent medical visitor who assessed the woman on behalf of the court.
The judge made other orders aimed at ensuring the safe delivery of the woman’s baby in circumstances where she has not engaged in any way about a delivery plan.
Due to significant concerns about her mental and physical state, including her ability to tolerate a normal vaginal delivery and associated examinations, doctors said they considered the orders in the best interests of both woman and baby.
The orders, made under the High Court’s inherent jurisdiction, continue her detention in a medical facility and permit doctors perform a scheduled caesarean section and administer all other treatments and examinations considered in the woman’s best interests. If an emergency C-section is necessary, that may also be performed.
The orders were not opposed and were made on foot of medical evidence, including of the independent medical visitor, the woman is of unsound mind and incapable of managing her affairs.
The woman was not separately represented but the general solicitor will represent her interests at future applications.
The judge was told the application had been read to the woman and efforts were made by medical staff and her partner to explain it to her but she did not engage in any way.
Reports stated she is not speaking, is eating little and is not moving much, the judge noted. She had been admitted to a medical unit in a dehydrated and malnourished state and ceased taking her medications a year earlier.
He was satisfied she is getting very good care where she currently is.
The matter will return to court after the baby is born when the judge will review the situation, including concerning her mental illness and where the woman will be placed.
Mr Justice Kelly said his preference is the woman will be able to be with her child but that may not be possible and the child may also have to be taken into wardship.
Mr Leahy said Tusla is preparing a birth plan to take into account the interests of the woman, the child’s father and the child.
