About this case:

• Citation:
  [2025] IEHC 147
• Judgment:
  External link
• Court:
  High Court
• Judge:
  Mr Justice Mark Heslin

Delivering judgment for the High Court, Mr Justice Mark Heslin found that the making of the orders sought “is both a necessary and a proportionate response by this Court to vindicate and protect the fundamental rights of this vulnerable person who lacks capacity to make the relevant decisions”.

Background

The applicant, the Governor of a certain prison, brought an ex parte application permitting the transfer of the respondent prisoner to a hospital or other appropriate clinical setting so that nourishment and medical treatment could be administered involuntarily to him.

The applicant exhibited a number of the respondent’s handwritten notes to an affidavit, which contained statements including “Dear medical professionals, end of life treatment only for myself, I am on full hunger and liquid strike, please respect my right to pass from this world asap. Thank you, much appreciated”.

The respondent asserted in his notes that he would remain on hunger strike and would refuse medical treatment until the State restored his liberty. 

A medical report dated 3 March 2025 considered that the respondent was extremely weak and was on his sixth day of food and fluid refusal, and that he had not yet fully recovered from his previous period of food and fluid refusal.

The report opined that the respondent was at risk of irreversible organ damage after seven days. The case came before the High Court on the eighth day of food and fluid refusal.

The High Court

Mr Justice Heslin noted at the outset of his judgment that the policy in the Irish Prison Service is that a prisoner’s right to refuse nourishment should be respected, consistent with their individual rights to body integrity and self-determination, but predicated on the individual in question having capacity to so decide.

The court considered the evidence as to the respondent’s capacity, and in particular having regard to evidence of a Dr E who sent an email on the morning of the hearing which stated that the respondent had deteriorated overnight and that he had become psychotic and irrational.

Mr Justice Heslin quoted from the report: “He advised nursing staff this morning that he would cease his food and fluid refusal if the court was to make ‘a substantial financial offer’. He is refusing clinical assessments like blood pressure checks or urine analysis to monitor progress for potential kidney failure…In my opinion he at risk of sudden death and requires refeeding and rehydration immediately.”

In light of the differing views of the various medical professionals involved as to the respondent’s capacity, the court was satisfied to place greater emphasis on the evidence of a consultant forensic psychiatrist, Dr B, in light of her particular specialism and having regard to the “extremely detailed analysis which she has conducted and sets out in her report which runs to 21 pages”.

Highlighting her functional approach to the assessment of capacity consistent with the Assisted Decision-Making (Capacity) Act 2015, Mr Justice Heslin remarked that Dr B’s opinion to the effect that the respondent suffered with a complex persecutory delusional belief system which mediated his food and fluid refusal was consistent with the views of other medical professionals.

Being satisfied that the respondent lacked capacity to use and freely weigh his decisions to accept or refuse fluids, food and other medical interventions due to his mental illness, the court considered its inherent jurisdiction to make the orders sought in circumstances where no ‘statutory route’ was available as the ‘designated centre’, namely the National Forensic Mental Institution, was not in a position to provide the physical attention required by the respondent.

The High Court deemed it appropriate to grant declarations that the respondent lacked capacity, that the respondent required immediate regimes of appropriate nourishment and medical care notwithstanding his wishes, and that the applicant was entitled to take necessary and proportionate steps to preserve his life including transferring him to a hospital or other appropriate clinical setting and permitting the provision of medical, clinical, nursing and welfare services.

Conclusion

Accordingly, the High Court made the orders and declarations sought, to remain in force for so long as necessary to protect and preserve the respondent’s right to life and/or pending further order, and appointed a guardian ad litem to the respondent.

In the matter of the inherent jurisdiction of the High Court and in the matter of an application for Orders permitting the administration of nutrition to a person detained in prison [2025] IEHC 147