Leading Article: Rights and common sense

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THE case of 'J' must be among the most painful ever to come before the Court of Appeal. J's father died when she was five, her mother when she was eight, her much-loved grandfather two years ago, after which a foster family could not cope. Now 16, she has been for some time in a residential psychiatric unit.

Very little imagination is required to understand her reluctance to eat. Her self-

esteem must be somewhere near zero, her view of the world and the value of life about as negative as it is possible to get, her feeling of loss of control almost total. Food may be the last area of her life over which she feels she has power, and even that power is now being taken from her by the court. Few children could survive so much loss without damage. Surprisingly, perhaps, she does not appear to wish to kill herself, merely to control her fate and decide her own treatment.

The legal aspects of the case are open to dispute and have wide implications for local authorities, which is why the Lords may eventually be called upon to decide. The Family Law Reform Act of 1969 and the Children Act of 1989 define the requirements of consent by children of 16-18 to surgical, medical and dental treatment. J claimed that they gave her the right to refuse treatment. The Court of Appeal decided yesterday that they do not give her the right to starve herself to death or to the point of causing irreparable damage to her brain or other vital organs. Medical evidence indicated that the risk of such damage had become acute.

It can be argued that this ruling sets a dangerous precedent by diminishing the rights of adolescents to refuse medical treatment. It touches on wider debates about the rights of children, the responsibilities of local authorities towards those in care and medical ethics. Perhaps, as has been suggested, there would have been other ways of rescuing J, such as by invoking the Mental Health Act, under which even adults can be treated against their will. But the judges were not being asked to decide on that issue. Given the case as put to them, they would have set a horrifying precedent if their ruling had departed from common sense and natural human feeling.

Anorexia is a sickness, whether or not it is brought on by difficult circumstances. It warps judgement and distorts perception to such an extent that its sufferers often cannot see that they are thin when they look in the mirror. J has been diagnosed as a sufferer. She is still a child in most important respects, and those in loco parentis still have obligations towards her. She badly needs specialised help and treatment.

There can be legitimate professional disagreements over the best treatment for her case. No established or universally effective treatment for anorexia has yet been found. But to have allowed a child in her state to decide on her own treatment would have been to carry the rights of children to absurd extremes and beyond those of mentally disturbed adults. To have left her to inflict lasting damage on herself would have been cruelly negligent. Medical and human ethics alone surely require that the best possible efforts be made to save her. If the law is unclear in a case like this it should be re-examined. What matters now, as the judges rightly decided, is to find the most suitable treatment for this tragic case.

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