Anorexia, force feeding and best interest
The Court had previously given clear guidance in the Aintree case1 that when considering best interests, the welfare of a patient should be reviewed in the widest sense. A recent case2 has considered the application of this in the context of anorexia, force feeding and the Mental Health Act.
Ms X suffered from enduring and severe anorexia nervosa and alcohol dependence syndrome, which had caused chronic and now end stage, irreversible liver disease. Although she had been in treatment for many years for the anorexia, after discharge she routinely ingested large amounts of alcohol and lost weight.
The clinical team had come to the view, as a result of this continual circle of care and discharge, that it would be clinically inappropriate to admit her for compulsory feeding and sought a declaration that it would be not in her best interests under the Mental Health Act or otherwise, to force treatment on the patient. The official solicitor (representing her as her litigation friend), did not oppose the application.
The Court found that Ms X lacked capacity to litigate, although she had capacity to make some decisions about alcohol. It also found that an advanced decision about treatment for liver disease made previously was valid.
The Court acknowledged the highest priority to be given to the preservation of life, but acknowledged that there was a paradox here in that treatment for anorexia was likely to provoke “increased sustained and dangerous alcohol consumption which will (in the medical view), hasten Ms X’s death”.
The Court therefore concluded that the relief sought would be in Ms X’s best interests. The Judge also stated that he hoped that Ms X would “nonetheless realise that it would be of enormous benefit to her to access treatments… which may improve the quality of the limited life she has left to her, if not to render more dignified its passing”.
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Guidance for providers on the use of surveillance
On 16 December CQC published guidance for health and adult social care providers who may be considering or already use either hidden or open surveillance/cameras. The guidance is available on the CQC website. If further advice is required, RadcliffesLeBrasseur can assist with this.