Woman with severe anorexia has right to starve to death, US court finds

Anorexia nervosa has the highest mortality rate of any psychiatric disorder

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A court in America has ruled that a woman with severe anorexia has the right to refuse force-feedings and starve to death.

The 29-year-old, who weighs under five stone, entered a state psychiatric hospital in Morristown in the east US state of New Jersey in 2014.

Her request for end-of-life care was accepted after she told the court she didn’t want to be given food or water, reported the Wall Street Journal.

Anorexia nervosa, which causes sufferers to restrict the amount they eat to keep their body weight as low as possible, has the highest mortality rate of any psychiatric disorder.

In extreme cases, doctors in the UK can admit the patient to hospital for compulsory treatment under the Mental Health Act to prevent them from starving themselves to death.

The court heard the woman had received treatment for eating disorders, depression and substance abuse since the age of 13 and her lawyer said long-term malnutrition had caused her bone density to be similar to that of a 92-year-old.

The state argued that anorexia isn’t a terminal condition and her mental illness meant she was not competent to refuse treatment.

It also suggested depression suffered by the woman could be treated with ketamine, an experimental treatment often used as an illegal party drug.

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But her doctors told the court she was unlikely to recover from her illness and said force-feedings would be “inhumane”.

The Judge who made the ruling said the decision was supported by the woman’s family, doctors, psychiatrists and an ethics committee, and called her testimony “voluntary, steadfast and credible,” according to the newspaper.

He noted that US courts have previously upheld the right of patients or their families to refuse lifesaving medical treatment.

Guidelines allowing UK doctors to consider compulsory treatment for anorexia patients at risk of death were first published in 1997 after a woman who had suffered from anorexia since her teens died when doctors were advised that force-feeding could lead to assault charges.

According to the Mental Health Act, mental illness alone is not grounds for considering someone incapable of giving consent.

Dr Richard Sly, medical advisor for eating disorder charity Beat, told The Independent compulsory treatment for eating disorders was on the increase, but still relatively rare.

“To treat a patient against their will, that patient would need to be assessed by quite stringent standards by a number of professionals,” he said.

“It’s a difficult thing to do, and is only done as a last resort, when a number of professionals feel that patient’s life is in danger and are refusing treatment, or denying the seriousness of the situation.”

The number of people being treated under section for an eating disorder rose by 222 per cent between 2008 and 2015, Beat reported last year.

Dr Sly said for compulsory treatment to be withheld from anorexia patients would be a “massive, huge decision” and he had not encountered a case of its kind since he started working in the field 13 years ago.

He said although it was a “tricky situation” and could understand why some patients, their families and clinicians might feel exhausted and hopeless, he and other doctors in the field had a duty to continue to work towards the patient’s recovery.

“It’s our job to hold the hope for patients when they feel at their most hopeless. We always believe recovery is possible,” he said.

“I’ve worked myself clinically and have seen and treated patients under section, and seen them get better despite it seeming incredibly hopeless for them and us.”

In June 2012, the High Court ruled that a former medical student who suffered from severe anorexia and other chronic health conditions should be fed against her wishes.

It was ruled that the 32-year-old former medical student, known as E, lacked the capacity to make a decision over her treatment.

Those close to her said she should be left to have a "dignified death", but the judge said the state had a duty to continue her treatment, according to The Guardian.

However, in a separate case in August 2012, the High Court ruled a 29-year-old woman should not be force fed as it was not in her “best interests”.

The court heard that the woman from the north of England, who had spent 90 per cent of her life as an in-patient for the disease since turning 14, did not wish to die, reported the BBC.

Instead “all reasonable steps” should be taken to gain the woman’s co-operation without physical force, said the Judge.

If you have been affected by the issues in this article, contact Beat via b-eat.co.uk

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