Saturday 16 June 2012

Judge makes wise and courageous call in deciding to continue treatment of anorexia patient

A High Court judge ruled yesterday that it is in the best interests of a woman who suffers from ‘extremely severe’ anorexia to be fed against her wishes.

Mr Justice Peter Jackson found that the 32-year-old former medical student, who has other chronic health conditions, ‘lacked capacity’ to make a decision about life-sustaining treatment (full judgement here).

Sitting at the Court of Protection in London, the judge said it was a ‘very difficult decision’ to make in a situation requiring ‘a balance to be struck between the weight objectively to be given to life on one hand and to personal independence on the other’.

Her case had ‘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’.

Giving his conclusion in a judgment made public, he said: ‘The competing factors are, in my judgment, almost exactly in equilibrium, but having considered them as carefully as I am able, I find that the balance tips slowly but unmistakably in the direction of life-preserving treatment. In the end the presumption in favour of the preservation of life is not displaced.’

He declared that ‘it is lawful and in her best interests for her to be fed, forcibly if necessary’ and added that the ‘resulting interference’ with her rights was ‘proportionate and necessary in order to protect her right to life’.

He 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. 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.’

This judgement will no doubt be controversial as it raises questions of what the term ‘best interests’ means when applied to patients who lack mental capacity. But I believe the decision was the right one.

I was asked to comment by the Daily Telegraph yesterday and they have run part of my quote today.

My full statement was as follows:

Dr Peter Saunders, Campaign Director of Care Not Killing, said:

‘We welcome this ruling. The judge has made a wise and courageous decision in favour of life in this difficult and distressing case. In so doing he has emphasised that all human life is deserving of profound respect and strong protection and also that acting in the best interests of people who are lacking capacity does not always mean acceding to their demands. We do not always know what is best for us and to have abandoned this vulnerable woman at her point of greatest need would have been the wrong option. Where there is life there is still hope and by continuing with care and support there still remains the possibility that she may come to value her life and eventually respond to treatment for her severe anorexia. ‘

Further background to the case is reported in the Telegraph:

The unnamed patient, from Wales, was described as a highly talented and intelligent woman who held ambitions of having a family and becoming a doctor before she became seriously ill in her mid-twenties.

She had twice signed forms last year saying she did not want to be given treatment to keep her alive and had told the judge that she felt her life was ‘pure torment’ and that all her efforts to recover had failed.

The woman’s illness dates back to her childhood. She suffered serious sexual abuse between the ages of four and 11, unknown to her parents. At 12 or 13 she began binge eating and forcing herself to vomit, and started to drink alcohol.

When she was 15 she was admitted to a specialist adolescent eating disorder unit, and later began a medical degree. However, she began drinking heavily after a bad relationship and dropped out of university. Between 2006 and 2010, she spent more than half of her time in specialist units for eating disorders or alcoholism.

The authorities made an urgent application to the court last month because the woman was refusing to eat and it was believed her death was imminent.

I’m sure that many people will be praying for this poor woman in the hope that her treatment will be successful.


  1. It sickens me (actually and physically) that you chose to use this poor woman's case in a petty attempt to bolster your abusive position on the rights of patients to terminate their own lives.

    Whilst I believe the Judge made the right call I also believe it has nothing to do with the case for assisted dying.

    In particular I would like to address this part of your statement which is fallacious:
    Where there is life there is still hope
    That is never true for someone who is suffering from a terminal illness.

    1. This article is not actually about assisted suicide but about withdrawal of treatment. Perhaps you should have read it before commenting.

      Re hope, many people who have terminal illnesses have hope, not hope for a physical cure perhaps, but this is not the only hope worth living for.

    2. Dr Peter Saunders, Campaign Director of Care Not Killing,

      That is the "Care not Killing" who state one of their main objectives as Opposing euthanasia - are you suggesting that you didn't give those credentials to the press? Are you suggesting you weren't making that statement on behalf of Care not Killing? Of course you aren't, that would be silly, almost as silly as saying that this article is not about assisted suicide.

      Peter, please don't insult your readers intelligence by trying to dodge the truth.

    3. Yes of course I was quoted on behalf of Care Not Killing which opposes a change in the law to allow euthanasia.

      But this was not a case involving either the suicide act nor the murder law. It was a case about withdrawal of treatment and not active killing and was handled under the mental capacity act.

      Whether you agree or disagree with my views on assisted suicide or euthanasia is irrelevant. Each case needs to be viewed on its own merits.

    4. I quite agree that each case does need to be judged on its own merits, why then are you the spokesperson for Care not Killing which is against euthanasia?

      You cannot have it both ways, either you are against euthanasia or you admit each case has its own merits and there will be some where euthanasia is the preferred option.

    5. Goodness, just wondering if you have children, if yes would you decide like the judge or would you want them to starve to death like the patient. Many times when people are unwell they are not in a position to make wise decisions

  2. When first reading your post earlier today, unaware of the full facts of the case I was in agreement with you.

    Having read Dr No’s post here: I no longer do.

    Please read the judgement which is highlighted in the second paragraph.

    1. That gives a much fuller description of her case than anything I have read before, thank you. It also makes me want to rethink my previous support for the decision, I am no longer confident the Judge was right.

    2. Dr No's description of forced feeding is I think emotive and melodramatic. The relatives themselves, although they would have preferred that she just be allowed to die at this point were not opposed to one last try.

      I am not pushing a 'vitalist' position, that all treatments that might be given must be given to every patient. I am saying that there was a chance this poor woman might still come to value her life and respond to treatment. I have seen people in not dissimilar situations who were suicidal for years eventually respond and be very grateful that they were not, in their darkest hours, given what they so passionately asked for, that there were people who did not give up on them.

      The judge summed up the balance as follows and I think he got it right. I am not denying that it was a tough call and I am not saying that she should not be allowed to die if this last ditch effort fails:

      'No do I accept the proposition that one can only be certain about E's best interests if every possible solution has been tried and shown to fail. If taken too far, the argument that everything that can be done must be done carries the risk of discrimination against incapacitated persons by depriving them of options that are available to the capacitous...I acknowledge the significant risks involved in treatment, not excepting a risk to life. I acknowledge the modest prospects of success and the wholesale and prolonged invasion of E’s privacy and self-determination that is proposed. I acknowledge the high chance that, even if short-term progress can made, long-term difficulties will remain. I accept that E may rcover capacity only to make a valid advance decision. I accept that a resumption of treatment deprives E of an imminent and relatively peaceful death.These are all weighty factors. Against them, I place E’s life in the other scale. 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. 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.'

  3. I do not think Dr No's description of forced feeding is emotive and melodramatic at all but merely echoes that of what you read in the judgement.

    It is clear that E's life (to her) is devoid of quality and that she desires/wants an end to her pain. It is clear to me that the doctors involved in her case agreed with her wish to die - until the court case at which point they took a 'neutral' stance...

    You write "and I am not saying that she should not be allowed to die if this last ditch effort fails" which makes me wonder if this last ditch effort fails will it be followed by another last ditch effort?

    I am confused as to why you state that she should/might be allowed to die at a later date if this last ditch effort fails. Why not now - what is the difference between now and then - apart from the prolonging of her physical and mental pain?

    If you knew me Peter you would know that I agree with your opinions in many matters regarding the sancity of life - but in this case 'the striving officiously to keep alive' strikes me as wrong, very wrong and I cannot be swayed from that.

    With all due respect.

    Anna :o]

  4. I am shocked that anybody would think it right to allow somebody like E to kill themselves through not eating. Perhaps those who are advocating that she should be allowed to do this have not come into contact with people who suffer from eating disorders. I have friends who have been in the depths of depression and very close to death because of an eating disorder. They are now alive and well, thriving at university and in their personal lives. Maybe they will never fully recover, but they are very glad that their friends and family forced them to have hope (and therefore to eat!) when they could not imagine a time in their lives when they would be hopeful again. We must never forget that people like E are ill. As Dr. Saunders said, she was not in her right mind, she needed other people to be strong for her because she could not be. One day, I am confident that she'll look back and be glad that those who would have left her on the road to her own destruction were ignored!


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