High Court: Prisoner’s right to refuse necessary medical treatment is qualified by his status as a prisoner

About this case:

• Judgment:
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Justice Humphreys was satisfied that the prisoner lacked the mental capacity to properly understand the consequences of his refusal, but that in any event, the prisoner’s rights to autonomy, privacy, and bodily integrity were qualified by his status as a prisoner.

Background

CD, a convicted prisoner serving a life sentence for murder in Wheatfield Prison while awaiting a bed in the Central Mental Hospital, was admitted to Hospital X as a result of a self-inflicted injury to his neck with a homemade weapon.

The wound was not healing and CD refused to take prescribed medications for the infection, and exacerbated his injury by inflicting further wounds upon himself.

In the application to the High Court, the Deputy Chief Executive Officer of Hospital X asserted that CD required “immediate and continuing intra-venous antibiotic administration to reduce the immediate possibility of sepsis in his present condition”, and because of what Hospital X considered to be his psychiatric condition, he was likely to become uncooperative and might well require sedation.

While in Hospital X, CD was assessed by a Senior Registrar in Psychiatry, whose report referred to the view of the forensic consultant psychiatrist attached to Wheatfield that CD had paranoid ideas of delusional intensity, very limited engagement by CD, and “a likely schizophreniform psychosis”.

Furthermore, the psychiatrist stated that CD was unwilling to accept that he had a serious injury and he “lacked capacity to agree to the surgical procedure proposed by the ENT team” as he did not understand the issue, did not believe the medical advice given and was unable to properly weigh up the risks to him and communicate his comprehension and view.

Medical treatment was commenced by Hospital X prior to Court application, on the basis of the doctrine of necessity, however the hospital applied to the Court because of its understanding that there was no specific legislation that permitted the administration of medical treatment or surgery to CD other than by wardship, or recourse to the inherent jurisdiction of the Court which it invoked.

Legal issues

Justice Humphreys stated that where a patient lacks capacity, “the court must act on his or her behalf in the patient’s best interests. In the absence of special factors such as incurable and intolerable suffering, or the likelihood of a persistent vegetative state, those best interests generally militate in favour of receiving all treatment that is professionally recommended as prolonging life and indeed promoting the patient’s medical welfare more widely”.

Distinguishing Governor of X. Prison v. P.McD IEHC 259, in which the court declared that the prisoners decision “is valid” and “should remain operative” if he subsequently became incapable, Justice Humphreys questioned whether that would “imply that such a valid and operative decision precludes the possibility of State action to override it if the executive (or persons, such as Hospital X, acting on their behalf) so decides (whether with or without a court order)”.

In Justice Humphreys view, “such an approach was based on the false premise that a prisoner has a legal entitlement to exercise his or her autonomy in a manner which would frustrate the order of the court remanding or sentencing him or her”, and that no such entitlement could co-exist with the doing of justice.

A prisoner simply does not have any legal entitlement to cheat justice, and the Court should not co-operate in him or her attempting to do so.

Justice Humphreys was satisfied that “…a further logical consequence of such an approach that if medical necessity was established, the person having custody of the prisoner (or a person to whom he or she has been entrusted) was entitled to administer such treatment, or if so decided, nutrition or hydration without the necessity of a court order, because the prisoner did not have a lawful entitlement to refuse consent in those circumstances”.

While seeking declaratory or injunctive relief may be a prudent step, Justice Humphreys was satisfied that action taken by prison management to prevent a prisoner’s life being put at risk by neglect such as refusal of medical treatment was not unlawful even without such relief having been granted.

Accordingly, Justice Humphreys made an order compelling CD to undergo treatment, on the basis that as a prisoner in custody under a court order, he is not simply entitled to refuse treatment where this would either directly or ultimately put his life at risk and thereby frustrate the verdict and order of the court.

To that extent, CD’s rights to autonomy, privacy and bodily integrity were qualified by his status as a prisoner and his liability to undergo his sentence, which necessarily involves a prohibition on his frustration of that sentence by self-harm including harm by neglect or omission in relation to matters such as medical or surgical treatment, nutrition or hydration.

Order

Justice Humphreys ordered that Hospital X be authorised to: