The Governor of a Prison v A, 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 (Approved)

Factual and Procedural Background

This opinion concerns an application brought by the Governor of a prison seeking orders under the inherent jurisdiction of the High Court to permit the administration of nourishment and medical treatment to a male prisoner who is refusing food, fluids, and medication while detained on multiple remand warrants. The prisoner has expressed a clear wish to refuse nourishment and medical intervention, stating a desire to die by starvation until his liberty is restored. The application was made ex parte due to the urgency of the situation, with the prisoner’s health deteriorating to a grave and acute state. Prior proceedings included an earlier application in February, resulting in the appointment of a guardian ad litem but no substantive orders, as the prisoner had temporarily resumed accepting nutrition. The current refusal began again on 25 February, with the prisoner maintaining his stance indefinitely.

Legal Issues Presented

1. Whether the Court’s inherent jurisdiction can be invoked to override a prisoner’s expressed refusal of nourishment and medical treatment on the basis that he lacks capacity to make such decisions.
2. Whether it is necessary and proportionate to make orders permitting the administration of nutrition and medical treatment despite the prisoner’s expressed wishes, in order to preserve his right to life.
3. The appropriate scope and limits of the Court’s intervention in balancing the right to life against the prisoner’s autonomy and self-determination.
4. The appointment of a guardian ad litem in the context of urgent ex parte proceedings involving a vulnerable individual lacking capacity.

Arguments of the Parties

The opinion does not contain a detailed account of the parties' legal arguments.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The Court carefully considered the evidence, particularly the affidavit evidence from the prison governor and the National Nurse Manager, alongside multiple clinical reports assessing the prisoner’s physical and mental health, and capacity. The clinical evidence indicated that the prisoner suffers from a paranoid psychotic illness impairing his ability to weigh information rationally, specifically in relation to his decision to refuse food, fluids, and medical treatment. While the prisoner understood and retained information about the consequences of refusal, his decision-making was anchored in delusional beliefs, negating his capacity in this domain.

The Court acknowledged the policy of respecting a prisoner’s right to refuse nourishment when capacity is present, but found that the prisoner currently lacks capacity. The Court noted the urgent and grave deterioration in the prisoner’s physical health, including the risk of irreversible organ damage and sudden death without intervention. Given that the prison lacks the facilities to provide the necessary clinical care, the Court found it necessary and proportionate to make orders permitting transfer to a hospital or other clinical setting and the administration of nourishment and medical treatment despite the prisoner’s refusal.

The Court also emphasized that the inherent jurisdiction is a jurisdiction of last resort, engaged only when no statutory route is available. The statutory route under the Criminal Law Insanity Act was not available because the designated mental health institution could not provide the required physical healthcare. The Court therefore granted substantive relief at the ex parte stage due to the urgency and vulnerability of the individual, balancing the right to life against the right to autonomy in light of incapacity.

Finally, the Court appointed a guardian ad litem to represent the prisoner’s interests going forward and directed that all relevant parties be notified efficiently. The orders were made subject to a short return date to allow for further consideration and the guardian’s involvement.

Holding and Implications

The Court’s final decision is to grant the ex parte orders sought, which include:

• A declaration that the prisoner lacks capacity to make decisions regarding treatment, nourishment, and welfare.
• A declaration that the applicant (Governor) is entitled and required to take necessary and proportionate steps to preserve the prisoner’s right to life.
• Orders permitting the transfer of the prisoner to an appropriate clinical setting for the provision of nourishment and medical treatment, notwithstanding his refusal.
• Orders permitting the administration of clinical, medical, nursing, and welfare services despite the prisoner’s expressed wishes to refuse.
• The appointment of a guardian ad litem to represent the prisoner’s interests in ongoing proceedings.

The orders are limited in duration, remaining in force only as necessary to preserve life or until further order of the Court. The decision directly affects the parties by authorizing intervention to protect the prisoner’s right to life in circumstances of incapacity. No new legal precedent was established beyond the application of established principles of the Court’s inherent jurisdiction and capacity law in this urgent and exceptional context.