Z NHS Foundation Trust & Anor v Patricia & Ors
[2023] EWCOP 41
North East London NHS Foundation Trust v Beatrice (by her litigation friend the Official Solicitor) & Anor
9 May 2023
[2023] EWCOP 17
Court of Protection
A woman with a very serious eating disorder is starving herself and wants to die. The judge decided she doesn't understand the dangers because her illness is making her think she's not ill, so the judge will decide what's best for her and will make decisions for her on medical care, and also on what she says in court.
Key Facts
- •Beatrice, a 50-year-old highly intelligent woman with a history of anorexia nervosa (36 years) and recently diagnosed autistic spectrum disorder, is refusing to eat, consuming only approximately 260 calories daily.
- •Her BMI is 11.5 (normal is 18.5-24.9), weighing 31.9kg.
- •She has stated that she wishes to die and has stopped taking vitamins and heart medication.
- •The court application concerns whether Beatrice lacks capacity to make decisions regarding her nutrition and hydration and to litigate.
- •The applicant, North East London NHS Foundation Trust, seeks declarations under s. 15 of the Mental Capacity Act 2005.
Legal Principles
A person lacks capacity if at the material time they are unable to make a decision for themselves because of an impairment of, or a disturbance in the functioning of, the mind or brain and unable to use or weigh information relevant to the decision.
Mental Capacity Act 2005, ss. 2(1) and 3(1)(c)
The court is not obliged to identify a precise causal link between the inability to make a decision and various viable causes.
Pennine Acute Hospitals NHS Trust v TM [2021] EWCOP 8
The weighing process involves engaging in the decision-making process, seeing various parts of the argument, and relating them to one another.
PCT v P, AH and The Local Authority [2009] COPLR Con Vol 956
If a person lacks capacity to weigh relevant information due to a condition, they likely lack capacity to litigate that very issue.
An NHS Trust v P [2021] EWCOP 27
Outcomes
Beatrice lacks capacity to make decisions about care and treatment options in respect of her nutrition and hydration.
Her anorexia nervosa prevents her from weighing the information relevant to the decision, namely the life-threatening consequences of her actions. The condition causes delusions about her body weight, overriding any rational assessment of her situation.
Beatrice lacks capacity to litigate the application.
Her inability to weigh relevant information due to anorexia also impairs her ability to formulate and make submissions to the court regarding her capacity. The court rejected the idea that capacity to litigate could exist if the individual could give unrealistic instructions to lawyers.