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In the BMJ huddle, the News team brought up the story that a high court judge has ruled that a former medical student who was anorexic and failed to respond to treatment and was being allowed to die should be force-fed.The patient was five weeks into a five week end of life care pathway when her local authority referred her case to the Court of protection in London. She had not taken any solid food for a year and her parents and clinicians had said that artificial feeding should not be forced upon her. This is a tragic case because the woman in question had been sexually abused between the ages of four to 11 and she said that the force feeding against her will was like reliving her years of abuse. In addition to this abuse, she had also developed a dependency for alcohol and was addicted to opiate medications and diagnosed with a personality disorder.
She has previously tried to refuse treatment but the judge ruled that she lacked the capacity to make this decision. He said that her obsessive fear of weight gain made her “incapable of weighing the advantages and disadvantages of eating in any meaningful way” and she was also now in a “drug haze” as a result of strong sedative medication. When a patient seems to lack the capacity to make the decision, the court then takes on the responsibility to come to a decision on what is in the best interests of the patient.
Her treatment is currently costing between £200,000 - 300,000 a year and a consultant psychiatrist who specialises in eating disorders has said her prognosis of recovery is between 10 - 20%
On his decision, the judge added “We only live once – we are born once and we die once – and the difference between life and death is the biggest difference we know. E is a special person, whose life is of value. She does not see it that way now, but she may in future”. The patient acheived highly at A-level and was bright enough to get into medical school and study for a few years.
This is an odd case because the patient is fully aware of what she is doing (i.e. not eating) but is not considered capable of making a decision on her treatment. This is a complicated case and I do hope she recovers.