A High Court Judge placed responsibility for the treatment of a fifteen year old girl in the hands of the court in order to help her doctors treat a life threatening condition, in a move he described as “unusual”.
In the case of Re A (A Child), the girl, identified as ‘A’, had been hospitalised for ten months. She had been confined to a bed for several weeks and weighed only five and a half stone at the time of the hearing. A key symptom of her condition was vomiting, up to thirty times a day.
Mr Justice Hayden said evidence suggested that decisions regarding A’s treatment should be made by an independent “authority figure”, so he temporarily separated the girl from her mother and make her a ‘ward of court’.
Several doctors consulted on the case yet no gastroenterological cause could be found to account for her symptoms. Neither A nor her mother would accept this conclusion.
The judge noted that the comments of a Dr Campbell:
“I have grave concerns that A is suffering under a form of fabricated and induced illness (the extent to which A is colluding with the mother remains to be seen). I would suggest that this goes beyond exaggerated illness behaviour … By removing the child from a potentially harmful parent it would then be possible to see to what extent the child would benefit from less invasive care.”
Meanwhile, a Dr ‘B’ told the judge A was “very malnourished indeed” and the best course of action was a feeding tube, but this was met with great resistance from the mother who wanted to pursue alternative treatments.
Mr Justice Hayden said:
“I have no doubt that this has been explained to the mother in clear and simple terms, it had been reduced to writing in a report. She had the benefit of a solicitor and extremely experienced counsel. Why in these circumstances with no expert evidence to support her alternative course and with Dr B saying in terms that it would be unethical to pursue it she continued to cleave to it as a possibility until so late in the day it is difficult to understand.”
Dr B spent time trying to convince A and her mother of the urgency oftreatment with no success. It was thought she could have no more than around eight to twelve weeks left to live if she continued without immediate intervention.
The girl was evaluated by two separate psychiatrists to assess her competence to decide upon her own treatment. They concluded that A was suffering from a “disorder of the mind or brain”, within the provisions of the Mental Health Act of 2007, and was therefore not competent enough to make those decisions.
Despite this finding, Mr Justice Hayden said he gave very considerable weight to A’s strong objections to the recommended course of treatment.
“The mother’s resistance to the only obvious course of treatment at a point where A has descended to a critical ‘red’ stage of malnourishment can only be interpreted as a dysfunctional understanding of her daughter’s needs, physically and emotionally. She is a lady who seems to me to be troubled psychologically, and I hope she will engage as soon as possible with appropriate experts to see if she can be helped. Despite all this I have no doubt that she wants the best for her daughter.”
Mr Justice Hayden also took what he described as another unusual step:
“[T]o visit her in hospital to let her know personally why she is a Ward of Court and why and by whom the decisions regarding her treatment has been taken. I have explained that it is neither she nor the Doctors who made the decisions. I have done so in the hope that the conflict between them may be reduced (a note of what I told her has been prepared, approved and filed with the papers).”
Photo by John M Kimmins under a Creative Commons licence