Mental health law briefing 182 – Court orders force feeding of anorexic patient
It has been clear for some time that patients suffering from anorexia who are detained under the Mental Health Act may be force fed using Section 63, on the basis that that is treatment for their mental disorder.
The Court has recently had to consider whether to order a patient who lacks capacity to decide but is not detained to be force fed.
The patient, a former medical student, had begun to control her eating from the age of 11. She had not taken solid food for more than a year and her body mass index had dropped to 11.3 (in contrast with a more normal BMI of 20). She had an obsessive fear of weight gain and her compulsion to prevent calories entering her system had become more important to her than anything else. The patient, her family and carers had embarked on a course of palliative treatment however, her case was referred to the court by the local authority because of issues concerning her capacity, and the validity of previous purported refusals to accept treatment.
The facts in this case were complex, and like many Court of Protection cases, the decision turns on the specific facts of the presenting case. The Judge confirmed that the patient’s views were “entitled to high respect”. He acknowledged that those who knew the patient best did not favour treatment. However, he commented that the case had “raised for the first time, 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 Judge ruled that the patient should be fed pursuant to the Mental Capacity Act on the basis that this was “proportionate and necessary in order to protect her right to life”. He commented that “we only live once – we are born once and we die once. [The patient] is a special person whose life is of value. She does not see it that way now, but she may in the future”. Although the Judge acknowledged that the treatment would be extremely burdensome to the patient, and he would not overrule her wishes if treatment was futile, there was a possibility that it would succeed and thus it was ordered.
Despite the Judge’s comments regarding the issue that life sustaining treatment might not be in the best interests of the individual, there have been similar such cases and this case simply reflects a further, perhaps even inevitable, application of the Mental Capacity Act. However, it is of note that the Judge commented that he only decided as he did because the statutory authorities had a care plan in place which they were prepared to see through. The provision of the necessary resources through the short, medium and log term were, according to the Judge, a key part of his decision.
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 See “Shield bearers – where does the Court of Protection stand on the concept of a “good death” – Andrew Parsons , Solicitors Journal, 30.11.10
This briefing is for guidance purposes only. RadcliffesLeBrasseur accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.