Letter: Legal dilemma over anorexia

Sir: Your leading article 'The rights and wrongs of treating anorexia' (18 May) rightly encourages preventive measures against death from anorexia. However, two assumptions are made which may not be justified and which have certainly never been tested in the courts.

You assume, first, that anorexia nervosa is sectionable under the Mental Health Act 1983; and, second, you assume that treatment to save life is statutorily permitted.

The only classification of sectionable mental disorder that anorexia could fall into is that of 'mental illness' under s1(1) of the 1983 Act.

The term is not defined further (unlike all the other forms of disorder permitting detention). Its very elasticity makes it possible that anorexia comes within its ambit, but, since medical opinion is far from unanimous, it would inevitably fall to the judges to decide on the facts of a particular case.

Doctors understandably wish to save life. But treatment designed to save life is not, of itself, 'treatment for mental disorder' (see ss. 60-63 of the 1983 Act). Assimilation of these quite separate ideas lies at the heart of the confusion over whether patients may, lawfully, be treated under our mental health legislation.

Even if anorexia is a form of mental illness, the treatment plan would have to be directed towards the underlying disorder and not the consequences (even if life-invading) of that disorder.

The Kendall case highlights the doctors' dilemma; it does nothing to resolve the very complicated legal issues engaged.

Yours faithfully,

RICHARD GORDON

London, WC2

18 May