North East London NHS Foundation Trust v Beatrice (No 2)
[2023] EWCOP 60
Z NHS Foundation Trust & Anor v Patricia & Ors
9 May 2023
[2023] EWCOP 41
Court of Protection
A young woman with a severe eating disorder is very ill. Doctors want to force-feed her to save her life, but she's terrified of it and says it makes her suicidal. The judge understands her fear but also knows she's very close to death. He decides against forcing her to eat *right now*, but strongly encourages her to agree to feeding tubes if her health takes another turn for the worse. He will revisit the decision soon.
Key Facts
- •Patricia, a 23-year-old woman, has suffered from anorexia nervosa since 2010.
- •She has spent significant periods in various eating disorder units, both voluntarily and compulsorily.
- •She has previously received nasogastric feeding against her wishes, finding it incredibly distressing.
- •A unanimous best-interests meeting in November 2022 decided to discharge her from specialist services and cease treatment.
- •Patricia expressed her wishes in an advanced statement, preferring home care and minimal intervention.
- •In December 2022, an application was made to the court regarding life-saving treatment for her eating disorder.
- •Professor Robinson's report concluded Patricia had capacity to litigate and that a plan A discharge was the best option.
- •Patricia was readmitted to hospital in April 2023 due to her deteriorating condition.
- •The court heard multiple applications regarding nasogastric feeding under restraint.
- •Patricia's liver function significantly deteriorated, raising serious concerns about her life expectancy.
- •The court heard evidence from multiple doctors and Patricia herself.
- •Patricia consistently expressed distress about forced feeding.
- •The court considered Articles 3 and 8 of the European Convention on Human Rights.
Legal Principles
Best interests of the protected person
Mental Capacity Act 2005
Articles 3 and 8 of the European Convention on Human Rights
European Convention on Human Rights
Outcomes
Refusal to order nasogastric feeding under restraint at this time.
Balancing the preservation of life with Patricia's autonomy and the potential for further harm from forced feeding; considering her recent improvement in calorie intake and the lack of a comprehensive risk assessment; believing that compulsion has not worked in the past and will likely not work now.
Determination that Patricia likely lacks capacity to make decisions regarding medical treatment.
Based on the lack of expert evidence regarding Patricia's capacity, the judge proceeded under section 48 of the Mental Capacity Act 2005.
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