A judge has made orders permitting doctors to urgently perform life-saving brain surgery on a mentally ill woman to remove a tumour pressing on her brain.
The president of the High Court, Mr Justice Peter Kelly, noted the undisputed medical evidence is that the surgery is necessary to save the 50-year-old woman's life and might also either cure or alleviate her psychiatric difficulties.
While an inquiry will be held later, on notice to the woman, as to whether she should be made a ward of court, he was satisfied from evidence from doctors, her psychiatrist, a medical visitor appointed by the court, and her solicitor that she does not have the necessary capacity, as of now, to instruct lawyers or to decide on consent to the proposed surgery.
During an outpatient appointment with a neurosurgeon, she acknowledged she had a growth on her brain but did not seem to appreciate the seriousness of this and felt natural treatment like cycling and yoga would cure it, he said.
She adopted conflicting positions on her condition when discussing it with her psychiatrist, her solicitor and the medical visitor and at times maintained there was no tumour.
He was satisfied the matter was urgent and, if the surgery is not carried out soon, “death is inevitable” within one or two years before which she will experience severe headache, paralysis, blindness and coma, perhaps within months.
The medical evidence indicated the tumour was benign and, if she had it removed, it might either cure or alleviate her psychiatric difficulties, he said.
Risk of death
As with all surgery, this intervention carried a risk including of death, which doctors clearly set out, but that risk was put at between 2 and 3 per cent. If the surgery was not performed, the evidence was that she faces death.
Earlier, he said this single woman came here some years ago from an eastern European country and seems to be an isolated person with no family supports.
She has no family here and seemed to have no family in her native country other than an elderly aunt who, when contacted, said she had not seen the woman in years and could not assist in relation to her medical history.
The woman was admitted earlier this year to hospital as an involuntary patient under mental health legislation after being found by gardaí damaging cars on the street where she lives.
She was paranoid about her boss being a member of the mafia experimenting on animals from around the universe and believed she was working on the streets as a special agent.
The view was taken she was psychotic, lacked insight, had multiple delusions and was behaving in a bizarre and threatening manner. She sought to discharge herself and was very unsettled when she could not.
Further examinations were ordered and brain and MRI scans confirmed a 7.4cm right frontal lobe mass in her brain.
She was urgently referred to a neurosurgeon and a neuropsychiatrist and the evidence was she has a large frontal brain tumour which was probably benign and urgently needs a craniotomy and possible excision to reduce pressure on her brain.
The evidence from two neurosurgeons, her treating psychiatrist, the medical visitor and her solicitor was that they believed she could not understand the information being given to her about the proposed surgery for the purpose of getting consent.
Doctors also believed her mental disorder may be a result of her brain tumour or is being exacerbated by it and she might perhaps have a better understanding post-surgery, the judge noted.
She had a past history of involuntary admission to hospital in her native country and may have gone untreated.
