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(Court of Protection, Eleanor King J, 30 August 2012)
The 29-year-old woman suffered from severe anorexia nervosa and obsessive compulsive disorder. From her early teenage years onwards she had spent the majority of her life in inpatient units, often being detained under the Mental Health Act 1983. Eventually her detention was rescinded after all treatment options had been exhausted and compulsory treatment had been shown to only reinforce her disorder and increase her disability.
When she was admitted to hospital for emergency treatment a Do Not Attempt CPR decision was taken and attempts to engage her in a re-feeding programme continued. She struggled to engage with the programme and after several months she weighed only 3 stones, had a body mass index of 7.7, her liver function was impaired, she had end stage organ damage, MRSA, her bone marrow was completely compromised and she was in significant pain from severe pressure sores. She had weeks to live. The medical evidence was that she would have to be forcibly fed by naso-gastric tube or percutaneous endoscopic gastrostomy (PEG) feeding. This course had close to a 100% chance of death. No patient with this BMI had ever survived.
The NHS Trust applied to the court seeking declarations that to continue with treatment including forcible feedings was not in the woman's best interests. During the course of the hearing the parties produced an agreed treatment plan which was approved by the court.
Due to the effects of the woman's anorexia nervosa she retained capacity in respect of some aspects of medical treatment but not in others. To avoid confusion the court made a declaration that while she did not have capacity to make decisions in relation to serious medical treatment including artificial hydration and nutrition, she retained capacity to make decisions as to antibiotic treatment and analgesia for treatment for pressure sores.
To continue with treatment was futile and would almost certainly result in death anyway. The treatment course would be overly burdensome and cause extreme distress to the woman. Even if she would agree to some small increase in her nutrient intake her organ failure was irreversible and her anorexia so severe and deep rooted that there would be no real possibility of her maintaining her co-operation.
It was therefore in the woman's best interests to make declarations sought by the local authority, and agreed by the parties.
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