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Alcohol became ‘only source of calories’ for anorexic woman

Hope that patient will recover capacity to make decisions about treatment after being force-fed

21 June 2012

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A 32-year-old woman suffering from extreme anorexia and for whom alcohol had become the only source of calories should be fed against her will because she no longer had capacity to make decisions about life-sustaining treatment, the Court of Protection has ruled.

The case, Mr Justice Peter Jackson said, was the first in his experience of “the real possibility of life-sustaining treatment not being in the best interests of a person who, while lacking capacity, is fully aware of her situation”.

The death of the young woman, know as E, was “imminent”, the judge said, and that she twice last year tried to make advance decisions refusing the treatment that was now proposed.

Although E did not seek death, she didn’t want to eat or be fed, Peter Jackson J continued, “she sees her life as pointless and wants to be allowed to make her own choices, realising that refusal to eat must lead to her death”.

Recognising E’s unique situation the judge said it fell neither in the category of patients in a permanent vegetative state (PVS) nor in that of patients suffering from incurable terminal illness where continued treatment was not in their best interests.

In many ways, E was “the opposite of a PVS patient or a patient with an inevitably fatal condition” and was described as “an intelligent and charming person”, he said.

To decide on a course of action, the judge said, the first question would be to decide whether a person had capacity, and, second, if not, what decision was in her interest.

E had a happy early childhood but started binge eating and inducing vomiting after being abused in her teenage years.

She later recovered partly and set out to study medicine, where she achieved highly before dropping out after a difficult relationship.

A pattern began to emerge as she moved from relative stability to crisis, with alcohol representing “her only source of calories”.

E would regularly be admitted to hospital for treatment, with doctors divided over whether she had capacity to make advance decisions about her treatment, including preventing others from feeding her.

On the application of E’s local authority, the court found in A Local Authority and E v A Health Authority and E’s parents [2012] EWHC 1639 CoP that E suffered from such severe anorexia and that, because of the strong sedatives she was now under, she lacked capacity to make decisions about her treatment.

In the circumstances, it was in her best interests to be fed, “forcibly if necessary”, the judge said.

However, he noted: “I acknowledge that a person with severe anorexia may be in a Catch 22 situation regarding capacity: namely, that by deciding not to eat, she proves that she lacks capacity.”

The hope, he concluded, was that “with refeeding, E will reach the point where her weight stabilises at a more normal level and leads her to recover the capacity to take decisions for herself”.

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