The president of the High Court has made “urgent” orders permitting doctors to immediately administer a blood transfusion to a woman who might otherwise not survive the next few hours.
Mr Justice David Barniville made the orders to vindicate the woman’s constitutional rights to life and bodily integrity after hearing from doctors who believed she does not currently have the mental capacity to consent to necessary procedures due to mental illness.
He said a failure by the court to immediately intervene, at a hospital’s request, could have “catastrophic consequences” for the woman.
A consultant endocrinologist told the court on Tuesday that he has never seen a haemoglobin count as low as this woman’s, which was at 3.3 grams per decilitre upon her admission to hospital on Monday night from a mental health facility. The court heard it has since dropped to 3.1, far below healthy levels of between 12 and 15.
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Haemoglobin is a protein in red blood cells that carries oxygen throughout the body.
The doctor said the woman’s haemoglobin count could drop further, which would likely cause her death. The patient, who is aged in her 40s, is in a “critical” position and requires a blood transfusion on Tuesday, he said.
She did not engage with the medical team and at times refused to allow checks of her vital signs, he said. The team had to sedate her to take further blood samples, and he could not be certain she would agree to the blood transfusion, he said.
He believes she cannot understand the seriousness of her condition and her need for treatment, he said.
After she is stabilised, she will likely need an investigative and therapeutic procedure, called a gastroscopy, on Wednesday, he said. This procedure – involving the insertion of a tube camera through her mouth into her stomach – should help the team to determine the source of a likely internal bleed, or possible other issue, that is causing her haemoglobin levels to drop, he said.
A consultant psychiatrist said the woman was in recent days admitted under the Mental Health Act to a treatment centre after gardaí were alerted about her acting strangely.
The woman, who was not previously known to mental health services, presented in a “very unusual manner”, was very suspicious and was probably experiencing a first episode of psychosis, the doctor said, adding that they have not yet been able to identify her next of kin.
The psychiatrist said she believes the woman’s mental illness prevents her from making decisions about her care.
Mr Justice Barniville was satisfied he should make orders sought by barrister Sarah McKechnie on behalf of the hospital.
He noted there is an “extremely serious risk to her life” from potential organ failure, including cardiac failure, and a “real question mark” about her capacity to consent to treatment that is “critical at this point”.
He said the woman’s medical history was not known to doctors, and there was no information before him about whether the woman ascribed to religious beliefs not to have blood transfusions. He said the circumstances were so urgent he could not adjourn the case to inquire about any potential religious obligations.
Her constitutional rights to life and bodily integrity were engaged and there was a “very real risk that the [woman] would not survive the next few hours”, let alone to an adjourned hearing date, if he did not immediately make the orders sought.
He granted orders permitting doctors to carry out the blood transfusion and other necessary procedures, such as the gastroscopy under sedation, if required. He also ordered that nothing could be published that would identify the woman.
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