Z NHS Foundation Trust & Anor v Patricia & Ors
[2023] EWCOP 41
East Suffolk and North Essex NHS Foundation Trust v DL & Anor
27 October 2023
[2023] EWCOP 47
Court of Protection
A very sick woman doesn't want to eat or drink and can't decide for herself. The judge decided the best way to help her is to put her to sleep with medicine, then feed her through a tube while she's asleep, because forcing her to eat would be too scary and make her worse.
Key Facts
- •DL, a woman in her thirties with a mild learning disability, complex PTSD, dissociative disorder, and emotionally unstable personality disorder, is refusing nutrition and hydration, leading to life-threatening emaciation.
- •DL lacks capacity to make decisions about her nutrition and hydration.
- •All parties agree DL wishes to live, but dispute the best treatment plan.
- •Initial treatment plans involving NG tube feeding with restraint were deemed unmanageable due to DL's violent reactions and lack of appropriate trained staff.
- •A revised plan involving deep sedation and PICC line feeding on an ICU was proposed and accepted.
Legal Principles
Declaration of lack of capacity
Mental Capacity Act 2005 (MCA 2005)
Best interests determination
Mental Capacity Act 2005 (MCA 2005)
Court of Protection jurisdiction in relation to medical treatment for incapacitated individuals detained under the Mental Health Act 1983
Mental Health Act 1983 (MHA 1983), MCA 2005
Balancing medical opinions with other evidence in best interests decisions
Case law (various cited cases)
Outcomes
DL lacks capacity to make decisions about her nutrition and hydration.
Based on evidence from Dr A, DL understands the risks but cannot weigh them to make a decision.
Feeding DL via a PICC line under deep sedation on the ICU is lawful and in her best interests.
The court deemed the initial treatment plan involving NG tube feeding and restraint unmanageable and likely to cause further trauma. The escalation plan (deep sedation and PICC line) minimizes trauma, respects DL's wishes to live and be 'put to sleep,' and offers a chance of recovery, while acknowledging risks associated with sedation.