Case Commentary: Northamptonshire Healthcare NHS Foundation Trust and AB [2020] EWCOP 40:

This case was brought before the Court of Protection (“the COP”) to make a health and welfare ruling on whether AB (the respondent) had capacity to decide on further treatment for her Anorexia Nervosa and whether it was within her best interests to receive this treatment.

Background:

AB is a 28 year old woman who has struggled with a chronic form of Anorexia Nervosa for 15 years, weakening her physical condition to a fragile state and placing her at serious risk of death. The only treatment option available to AB was to insert a feeding tube into her stomach, an option AB did not want and was likely to forcibly resist, creating further heightened risks of physical injury.

It was the NHS Trust (who applied to the COP) for an Order setting out two grounds:

1.  That it was in AB’s best interest not to receive any further active treatment for her condition, and;
2.  That AB lacked capacity to make decisions about her treatment concerning her anorexia nervosa.

Mrs Justice Roberts set out in her judgement that it would not be in AB’s best interest to undergo forced nasogastric feeding, as indeed she would resist this treatment, exposing herself to further risk of injury. The only other viable option would require sedating AB, but the team’s consultant psychiatrist advised against this, as she would need to be hospitalised for at least six months. The views of AB, her parents and professionals aligned on this matter with no party seeking further treatment for AB. Instead the plan to provide palliative care as and when it would be needed was declared by the Court to satisfy the first ground detailed above.

On the second ground, Mrs Justice Roberts found that AB lacked capacity to decide on her treatment for anorexia nervosa. The medical evidence supplied during the hearing assisted the Court with its finding, as the manifestation of AB’s anorexia nervosa was so severe that it affected all decisions she made regarding gaining weight. Subsequently, the overriding compulsion to not put on weight meant that she would not be able to make an informed judgement in connection with further treatment, which would inevitably involve her trying to decrease her calorie intake.

This case differs from other best interest cases on the issue of anorexia nervosa, since AB showed clear acceptance and understanding that her life was at risk if she did not continue her treatment. She had found value in her life spending time with her family, whilst accepting that her illness is only part of who she is, and to undergo further treatment would be as if she were ‘being punished twice: once by having the illness, and once in an attempt to treat it’. AB’s position here was also supported by the care team, who appreciated that the physical and psychological trauma inflicted upon AB through the only viable treatment option available to her fell outside the scope of her best interest.

Henceforth Mrs Justice Roberts made the order sought by the NHS Trust accordingly, namely that it was not within AB’s best interest to receive further interest and that she lacked capacity to make decisions concerning her treatment.

*Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*