The judge said he had "no doubt" that he had the power not only to direct the 16-year-old girl to a clinic, but also to authorise the use of reasonable force to keep her there after hearing evidence of her eating disorder, subjection to sexual abuse and a suicide threat.
While the judge, Mr Justice Wall, was acting under the jurisdiction relating to children and young people, where a child's "best interests" are the dominant criteria, the ruling will rekindle the debate over judges' increasing willingness to override the wishes of patients who refuse treatment.
The ruling was made last week in a private hearing in the High Court family division, but the judge gave permission for it to be reported because of the important principles involved.
The 16-year-old, who cannot be identified for legal reasons, began worrying about her weight at 12 and became anorexic at 14. She had also been a victim of long-term sexual abuse by a brother. Her history of eating problems included vomiting, taking laxatives and absconding from clinics where she was being treated. On one occasion she threatened to commit suicide and had to be restrained from throwing herself off a balcony.
Last November, she was admitted to hospital after eating no more than a few slices of cucumber in the previous 10 days.
The judge said doctors had reported that the girl had the ability suddenly to stop eating and drinking, putting herself at risk of collapse and death within the following three to seven days. There was no doubt, Mr Justice Wall said, that it was in the girl's best interests to be treated in the clinic. He was satisfied in addition that detention, using reasonable force if necessary, was an essential component of the treatment.
The case, brought by the girl's local authority although she is not in its care, may be of comfort to desperate parents faced with the trauma of an anorexic child who does not want to get better. But the ruling will raise new fears about the increasing tendency of doctors to seek authority for their actions from the courts, and the preparedness of the courts to back them up.
While the focus has recently been on enforced Caesarean sections on unwilling pregnant women, the British Medical Association raised fresh fears yesterday. A spokesman said: "We have general concerns about the use of reasonable force and how this is to be interpreted. In the past we have asked the Mental Health Commission to draw up guidelines to help professionals."
The BMA is in the process of considering new guidelines on children's consent to or refusal of treatment.Reuse content