Inherent Jurisdiction to Authorize Interim Detention and Care Orders for Adults Lacking Capacity: Necessity, Proportionality, and Periodic Review

Introduction

Health Service Executive v A ([2025] IEHC 278) is an ex tempore ruling of the High Court of Ireland delivered by Mr. Justice Mark Heslin on 7 May 2025. The case concerns a young adult born in 2001 (“A”) diagnosed with autism spectrum disorder, moderate intellectual disability, and ADHD, with limited verbal communication. The Health Service Executive (HSE) applied under the Court’s inherent jurisdiction to renew interim orders permitting A’s detention and care in a residential placement to which his mother (“Ms. D”) had come to object. The key issues are:

• Does A lack capacity to make decisions about his health and welfare?
• Are interim detention and care orders necessary and proportionate to protect his rights?
• What role do periodic reviews and multidisciplinary oversight play?

Summary of the Judgment

Justice Heslin found that:

• A lacks capacity in relation to his health, welfare, and finances, based on detailed psychiatric evidence (Dr. B).
• The placement, operated by a specialised care provider, is appropriate, safe, and compliant with regulatory standards (HIQA report).
• Interim orders made on 28 November 2024 remain necessary and proportionate despite A’s mother withdrawing her earlier consent.
• Periodic review—proposed for 12 November 2025—is essential to ensure orders remain no more intrusive than required.

Accordingly, the Court renewed the interim detention and care orders under its inherent jurisdiction.

Analysis

Precedents Cited

Although no specific Irish authority was directly cited in the text, the decision rests on established principles:

• Inherent Jurisdiction of the High Court: The power to protect vulnerable adults, recognized in Re C (Adult: Refusal of Treatment) [1994] 1 WLR 290 and applied in subsequent Irish cases.
• Bournewood v United Kingdom (1998) 27 EHRR 213: The European Court of Human Rights underscored that deprivation of liberty of incapacitated adults requires adequate procedural safeguards.
• Mental Health Act 2001 (Section 3): Defines “mental disorder,” but the Court distinguished prison-like detention under this Act from the autism-friendly, community-based placement here.

Legal Reasoning

The judgment’s reasoning unfolds in stages:

1. Capacity Assessment: Dr. B’s detailed functional assessment concluded that A cannot understand risks (e.g., traffic danger) or make informed decisions. His cognitive impairments are lifelong.
2. Necessity and Proportionality: The Court applied a balancing test: the orders intrude on A’s liberty, but they are essential to prevent serious harm and to uphold his human rights (including bodily integrity). The HSE’s placement provides tailored supports that an approved mental health centre would not.
3. Procedural Safeguards: Interim (not final) orders, subject to a six-month review, ensure ongoing judicial oversight. The guardian ad litem, HIQA inspections, independent social worker reports, and multidisciplinary team updates provide layered checks and balances.
4. Best Interests and Family Objections: While the mother’s sincere distress was acknowledged, her objections—lacking evidence—could not outweigh expert assessments demonstrating the placement’s efficacy and A’s wellbeing.

Impact

Health Service Executive v A reaffirms and clarifies the High Court’s inherent jurisdiction to:

• Authorize interim detention and care for adults lacking capacity when no suitable alternative exists.
• Insist on necessity, proportionality, and periodic judicial review as safeguards against arbitrary deprivation of liberty.
• Emphasize multidisciplinary, community-based placements tailored to the individual’s needs.

Future cases will likely cite this ruling when balancing parental objections against expert evidence and human rights considerations. It may prompt more rigorous capacity assessments and foster development of autism-friendly community placements.

Complex Concepts Simplified

• Inherent Jurisdiction: The High Court’s ancient power to protect those who cannot protect themselves, separate from statutory schemes.
• Capacity: A person’s ability to understand, retain, and use information to make a decision; here assessed by a consultant psychiatrist.
• Interim Orders: Temporary court orders that remain in force until a full hearing or further review confirms or varies them.
• Guardian ad Litem: A court-appointed guardian who represents the best interests of a person (A) in legal proceedings.
• HIQA: The Irish Health Information and Quality Authority, which inspects and regulates care services to ensure quality and safety.

Conclusion

Health Service Executive v A ([2025] IEHC 278) is significant for its robust application of the High Court’s inherent jurisdiction to protect a vulnerable adult lacking capacity. It underscores three core principles:

• Necessity: Orders must only go as far as required to prevent serious harm.
• Proportionality: Any restriction on liberty must be balanced against the individual’s rights and tailored to their needs.
• Periodic Review: Interim orders demand regular judicial oversight to confirm they remain justified.

This ruling sets a clear precedent for balancing expert evidence, human rights, and family interests in decisions about the care and detention of adults who lack capacity.