The right to force feed

[Gob]

Anorexic woman from Wales to be force fed, judge orders

The case was brought by the woman's local authority

A woman with "severe" anorexia who wanted to be allowed to die is to be force fed in her "best interests" by order of a High Court judge.

Mr Justice Peter Jackson declared that the 32-year-old from Wales, who cannot be identified, did not have the capacity to make decisions for herself.

He made public his judgment on Friday after making the ruling last month.

But Glyn Davies, Conservative MP for Montgomeryshire, used Twitter to criticise the judge's ruling.

He tweeted: "Shocking that judge orders anorexic Welsh woman be force fed against her will.

"She should be allowed to die with dignity. Shameful decision".

The case was brought by the woman's local authority, which also cannot be identified.

The court heard that the woman - known only as E - had altered her living will.

Initially, it said she wanted to die when the time came and she did not want to be revived.

Later, she said she wanted to live and wanted to make her own decisions about her future.

The judge, sitting in the Court of Protection, said it was a "a very difficult decision" for him to make because it required "a balance to be struck between the weight objectively to be given to life on one hand and to personal independence on the other".

Giving his reasons, the judge said that although she was "gravely unwell, she is not incurable".

He said: "She does not seek death, but above all she does not want to eat or to be fed.

"She sees her life as pointless and wants to be allowed to make her own choices, realising that refusal to eat must lead to her death."

When her case was brought to the court last month by the unnamed local authority the judge said: "E's death was imminent. She was refusing to eat and was taking only a small amount of water.

"She was being looked after in a community hospital under a palliative care regime whose purpose was to allow her to die in comfort."

He revealed that the "intelligent and charming" woman began to control her eating at the age of 11 and had not taken solid food for over a year.

The judge said the balancing exercise had to be intuitive and considering all the factors.

He added: "On one side, I have been struck by the fact that the people who know E best do not favour further treatment. They think that she has had enough and believe that her wishes should be respected.

"They believe she should be allowed a dignified death."

He acknowledged that her parents were in an "impossible" position and that "does not merely entail bodily intrusion of the most intimate kind, but the overbearing of E's will in a way that she experiences as abusive".

The judge said that E's own views were "entitled to high respect" adding: "She is not a child or a very young adult, but an intelligent and articulate woman, and the weight to be given to her view of life is correspondingly greater."

He said that he also had regard to the fact that the application was only brought after E and her family and carers had embarked a long way down the course of palliative treatment.

He said: "The state is now seeking to intervene very late in the day and a return to compulsion will be excruciating for them."

The judge added: "E is a special person, whose life is of value. She does not see it that way now, but she may in future.

"I would not overrule her wishes if further treatment was futile, but it is not. Although extremely burdensome to E, there is a possibility that it will succeed.

"Services and funding will now be provided that were not available before and it would not be right to turn down the final chance of helping this very vulnerable young woman."

Thoughts?

[Scooter]

She has a psychiatric disorder and as such is not competent to make such decisions for herself.

[Gob]

That would be my thoughts too. We force psychiatric patients to take medication against their will, including injectables and ECT, so why not food?

[Grim Reaper]

If this was about a person with depression and suicidal tendencies being forced to take medicine, it wouldn't have made the front page. But throw in "force fed" and suddenly it's a story.

[Gob]

Interesting no? Just been discussing this with one of my colleagues, who is a nurse, and who has worked in anorexic care. There is no right, she believes, to force feed ano's in Aus. However, if they go into a coma, they can be "medically treated" which would involve rehydration with various liquids and this would include life supporting liquid foods.

[Gob]

Also of interest is wether anorexia should be considered a "mental illness" or a "personality disorder".

[Lord Jim]

Also of interest is wether anorexia should be considered a "mental illness" or a "personality disorder".

Another interesting question would be what exactly is the distinction between a "mental illness" and a "personality disorder"

It seems to me that the characterization "personality disorder" is of fairly recent vintage....

It's struck me as just a more polite and PC way of saying "nuts" rather than "mental illness".....

[Gob]

Here's Wiki's preamble on PD Jim,

Personality disorders are a class of personality types and enduring behaviors associated with significant distress or disability, which appear to deviate from social expectations particularly in relating to others.

Personality disorders are included as mental disorders on Axis II of the Diagnostic manual of the American Psychiatric Association, and in the mental and behavioral disorders section of the ICD manual of the World Health Organization. Personality, defined psychologically, is the enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. In general, personality disorders are diagnosed in 40-60 percent of psychiatric patients, which is the most frequent of all psychiatric diagnoses.

These behavioral patterns in personality disorders are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress or depression.[5] The onset of these patterns of behavior can typically be traced back to early adolescence and the beginning of adulthood and, in some instances, childhood.

Because the theory and diagnosis of personality disorders stem from prevailing cultural expectations, their validity is contested by some experts on the basis of invariable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.

[Lord Jim]

Here's Wiki's preamble on PD Jim,

Yes, just as I suspected...

The difference between a "mental illness" and a "personality disorder" is so lacking in meaningful distinction that it's not even worth mentioning...

[dales]

One is the sub-set of the other, Jim.

Hope that helps.

[rubato]

Someone suffering from long-term malnourishment might have substantially reduced mental functioning caused directly by starvation. I might think about a time-limited order to force feed her until we can eliminate that possibility. And then allow her to die if it is still her wish. She is almost certain to die soon no matter what is done. Long-term starvation causes serious and permanent damage to a lot of parts of the body; heart muscle is digested, for example.


yrs,
rubato

[MajGenl.Meade]

There is no right, she believes, to force feed ano's in Aus.

In the northern hemisphere it's usually done oesophageally.

[BoSoxGal]

She doesn't have a terminal illness, she has a psychiatric disorder. I'm puzzled as to why it took so long for medical folks to seek a court order to force feed, and why she was being treated in a palliative care unit like a terminal cancer patient. They were assisting her suicide; I didn't realize that was legal in the UK? Assisted suicide should be for the terminally ill, anyway, not psychiatric patients.

I've known recovered anorexics; one struggles with the underlying issues forever, as with any serious psychiatric disorder - but one can still live a life of good quality.

[Jarlaxle]

Give her a fifth of Scotch and a bottle of sleeping pills, along with detailed instructions on doing it right.

[Big RR]

BSG--putting anorexia aside, if someone makes a rational decision to end his or her life, for whatever reason, do you think they should be able to do so witout the interference of medical or other personnel (absent, of course, ending it in a way that might endanger others, such as driving down the freeway at an excessive rate of speed). I do, and i don't think anyone has the right to impose one's will on them to force them to change the decision.

I find your statement that a doctor(or other healthcare worker) not acting to contravene the will of a patient is assisting in a suicide disturbing because ultimately we should each have a right to deciide or refuse medical treatment without fearing that we will have it imposed on us, whether or not we ar diagnosed as terminally ill. I will agree that she may be incapable of making the decision rationally because of her disorder, but that is far from a certainty. Someone choosing to starve themself to death may be anaorexic, or may (s)he may just want to kill him/herself. If the latter, I see no reason to give medical personnel the right to interfere with that decision.

[BoSoxGal]

Fine; then she needs to leave the medical facility and go home to starve to death, or blow her brains out, or overdose on pills.

It's unethical to expect medical personnel who swear an oath to preserve life to assist her in dying when she isn't terminally ill.

As the judge said:

“E’s case has raised for the first time in my experience 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 said.

However, he concluded: “E is a special person, whose life is of value. She does not see it that way now, but she may in future. I would not overrule her wishes if further treatment was futile, but it is not. Although extremely burdensome to E, there is a possibility that it will succeed.”

[Big RR]

Leave? Perhaps. But then the judge's remarks would appear to prevent that as well.

[BoSoxGal]

Not before the action was filed; if she wanted to commit suicide, she needed to have the cajones to do it alone where there was no sane party compelled to intervene. She can't expect medical personnel to stand by providing palliative care to a non-terminal patient.

I don't know how she came to be admitted to hospital, so I won't address the specifics with regard to that. What I've read informs me that she is incompetent to make decisions regarding her medical treatment and I don't believe the court has much choice but to order her force fed.

Unless the argument is that we should aid and abet the suicides of depressed and otherwise mentally ill people?

[Lord Jim]

I would like to take this opportunity to associate myself entirely with the remarks BSG has made in this thread.

[Andrew D]

The ultimate decision whether to accept life-sustaining care should be hers.

There is a case to be made for some people's incompetence to make their own medical decisions. People who are convinced that they are being poisoned by extraterrestrial aliens. People who believe that slitting their wrists will not kill them but will release the homunculi in their veins to liberate humanity. Unconscious people. Etc.

But this person does not appear to be one of those. This person appears to understand her actions and their consequences. Nothing more should be required.

(A short-term externally-imposed hold to ensure that she is not just having a momentary suicidal episode would be appropriate. But it would be appropriate precisely because it would be intended to ensure that suicide is what she really wants. As such, short-term should in fact be short.)

The contention that she has merely a psychiatric disorder rather than a terminal one leads to vicious circularity: "You are not competent to decide that you want to die. How do we know that you are not competent to decide that you want to die? Because you want to die."

Other than the fact that she wants to die, what evidence is there that she is incompetent to make decisions regarding her medical treatment?