A High Court judge was asked to rule today that force-feeding would not be in the “best interests” of an anorexic woman whose weight is just over three stone.
Mrs Justice Eleanor King, sitting at the Court of Protection in London, heard that the "highly intelligent" 29-year-old did not wish to die, but "suffers with serious and enduring anorexia nervosa".
Now weighing around just 3st 2lb (20kg), she has suffered from anorexia from the age of 12 - and since turning 14 has spent 90% of her life as an in-patient.
Details of the "parlous state" of the woman, who cannot be named for legal reasons, but is referred to as L, were given as an NHS trust asked the judge to make a declaration that it would "not be in her best interests" for L to be subjected to "forcible feeding".
Bridget Dolan, for the trust, said the case, from the north of England, involved "a serious medical treatment matter".
Describing the seriousness of the woman's condition, Ms Dolan said: "It has reached a point where the NHS trust who have her physical care are of the view that force-feeding is not in her best interests, notwithstanding that it is probable that if not fed she will die."
She was in a psychiatric unit until March when "her physical state became such that it was believed she was likely to die without physical treatment".
Her BMI (body mass index) is at the "extremely low level" of 7.7, said Ms Dolan, adding: "To some extent she has defied expectations and continued to live at such a low weight."
Ms Dolan said L has no wish to die. She "doesn't express a wish to die and that is certainly not part of her motivation in refusing nutrition and hydration".
But her severe anorexia - a condition which creates a "morbid fear" of ingesting any calories that might lead to an increase in weight - "does not allow her to eat".
Ms Dolan said the woman was "only agreeing" to receive 600 calories a day through a tube, which was "insufficient to maintain her current weight and certainly could not allow her to put on weight".
She told the court: "The issue is what do the doctors do? Do they force-feed her against her wishes, or do they allow her to be the barometer by which the decision about how much nutrition she takes in is made."
The woman agreed on August 2 to comply with naso-gastric tube feeding, but the case concerned what should be done if she refuses to continue being fed in that way - and whether treatment should be carried out forcibly against her wishes.
After hearing the evidence, the judge later announced that she was "able to conclude" that it was "appropriate" and in L's "best interests" to make the declarations sought.
She ruled that L lacks capacity in relation to decisions on whether or not to refuse nutrition and hydration.
The judge declared that it would be in L's best interests for her clinicians to be permitted to provide nutrition, hydration and medical treatment to her "in circumstances where she complies with that administration, including where nutrition and/or hydration is delivered by means of a naso-gastric tube".
She further declared that the clinicians should be permitted "not to provide L with nutrition and hydration with which she does not comply where such treatment cannot be delivered without her co-operation and/or without the use of physical force".
The order states that "all reasonable steps" should be taken to gain her co-operation "through the use of appropriate verbal explanations and persuasion, including, where appropriate, involving her parents, or such other person in whom she might have some trust, in attempts to persuade L to accept the said interventions".
It also states that: "Should L's condition further deteriorate such that in the opinion of the treating clinicians she has entered the terminal stage of her illness, to provide L with such palliative care and related treatment (including pain relief and anxiolytics) under medical supervision to ensure that L suffers the least distress and retains the greatest dignity until such time as her life comes to an end."
The making of the order was not opposed by the woman's parents, who attended the hearing, or the Official Solicitor, who represented L's interests.
Mrs Justice King was told L's parents wanted everything to be done for their daughter as long as it did not cause her any distress.
After giving her decision, the judge told L's mother and father that they had been "extremely brave" and that L was "very fortunate to have such parents".
L's mother described her daughter as a "lovely" person - when she first "became poorly" no-one had envisaged what was going to happen "in a million years".
The judge said that from what she had heard "this is not going to be a battle she is going to win".
She told the parents: "The task for everyone now is to make these last weeks - and I hope it is longer and not shorter - as comfortable for her as possible and for you to have as much time as you possibly can together."