Mental health law briefing 198 – Is forcible feeding always medical treatment?
There is now a well-established line of authority to confirm that forcible feeding of those suffering from an eating disorder is medical treatment for mental disorder within the meaning of the Mental Health Act. However, to what extent can this be said to be the case where the mental disorder is not an eating disorder? The Court has recently had to consider this.
The patient was an Iranian doctor. He was on hunger strike as he was protesting against the refusal to grant him asylum status. He had been admitted to hospital and diagnosed with a delusional disorder. He had also been assessed as lacking capacity. He was initially fed via a naso gastric tube with the authority of an Interim Order from the Court of Protection. The patient’s views about dying were unclear.
The NHS Trust caring for him applied to the Court of Protection for declaratory relief as to:
- Whether the patient had capacity to make decisions about feeding
- If not what were his best interests
- What powers were available to the Court in view of the fact that this involved a deprivation of the patient’s liberty
The Court held that the patient was suffering from a delusional disorder and therefore lacked capacity either to litigate or to make decisions about feeding.
The Court also held that artificial nutrition and hydration was not “medical treatment” for his mental disorder pursuant to Section 145 of the Mental Health Act. This could therefore not be given to him under Section 63 of the Act. Although the patient had a physical disorder that was a consequence of his mental disorder, it was neither a manifestation nor a symptom of it.
Although the Court did not accept that Article 2 of the Human Rights Act meant that the Mental Capacity Act had to include a power to maintain life, the Court held that it retained its inherent jurisdiction (as long as this did not conflict with Article 5 of the Human Rights Act), and as it was in the patient’s best interest to receive forcible feeding, this was duly ordered.
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 An NHS Trust v A  EWHC2442
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