An Iranian immigrant who has gone on hunger strike needs to be forcibly fed because he does not have the capacity to decide whether he should starve himself to death, doctors told the High Court today.
The 50-year-old man, who cannot be named for legal reasons, stopped eating in May last year in protest at the UK Border Agency's refusal to return his passport.
The man, who appeared in court emaciated, with sunken cheeks but nonetheless chatting animatedly to his Farsi translator, claims he is making a protest against his treatment at the hands of the immigration authorities.
But doctors treating him say he suffers from a “delusional disorder” that hinders his ability to make a genuine decision based on free will.
The man's NHS Trust is asking Mr Jutice Baker, sitting in the Court of Protection, to allow them to use “such reasonable force and restraint that is neccessary” to administer both artificial nutrition and anti-psychotic medication. Over the past few months his weight has hovered around 45 kilograms with an equivalent body mass index of 15 - the point where patients are categorised as severely underweight.
A temporary order has been in place since December allowing doctors to force feed the man via a nasal tube and the court must decide whether to make such an order permanent. Clinicians also want to be able to administer anti-psychotic medication but in lower doses than normal because he has lost so much weight and doctors are not sure how his body will react to the drugs. He often has to be sedated to receive nutrition. But without force feeding, doctors say, the man would would die within 10 days if he stopped taking water and within 35 days if he refused artificial nutrition.
The man, who was a doctor in Iran and is expected to give evidence in court tomorrow, came to Britain in August 2011 on a six month visa to learn English. He applied for asylum and was turned down twice. In May 2012 the UK Border Agency confiscated his passport and said they would only give it back if he returned to Iran.
The man went on hunger strike but shortly afterwards he was sectioned under the Mental Health Act and has remained in hospital since July.
His consultant psychiatrist, who cannot be named but works at an NHS Trust based in the South East of England, took the stand to detail how the man was a “complicated patient” whose delusional disorder stopped him from making balanced decisions about his life.
She detailed how he has a “relatively rare delusional disorder” with persecutory elements. He often believes Iranian security agents are monitoring him, has shown paranoia towards the colour red and believes people have tried to poison him.
Although he has regularly shown a determination to starve himself to death, she said, he has also thanked doctors for saving him during instances when he has been accutely dehydrated and needed emergency treatment.
“He has said he would like a life ahead of him and he wants to live,” she said. “He wants to have a life, a job and he talks of things he'd like to do if he had a future.”
The Official Solicitor, the lawyer appointed by the government to look after those who lack capacity to make decisions for themselves, has agreed with the NHS Trust that it is in the man's “best interests” to receive “life-preserving treatment”.
Justice Baker has indicated that he will reserve judgement and make a final decision within the next two weeks.