In cases regarding medical treatment, judges sometimes have to make difficult decisions urgently in very sad circumstances. Recently, the Court of Protection ruled that it was in the best interests of a woman with anorexia to be fed while under general anaesthesia.

The 20-year-old woman was currently an inpatient in an eating disorder unit and was detained under Section 3 of the Mental Health Act 1983. She was being fed using a nasogastric tube, but had developed the ability to regurgitate feed whilst it was being delivered and to vomit most of the remainder after delivery. Without effective intervention, it was likely that she would die soon. The NHS trusts responsible for her care applied to the Court for declarations that she lacked capacity to make decisions about her care and treatment, and that it would be lawful and in her best interests to admit her to an intensive care unit for feeding under sedation.

The Court heard evidence from a consultant psychiatrist who assessed her as lacking capacity. In his view, although she could understand and retain information, she did not have the ability to evaluate any option involving nutrition. However, he had formed the view that on some level she would want to get better. Although the proposed treatment plan carried considerable risks and was seen as an intervention of last resort, those treating and caring for her were unanimous that it was in her best interests.

The woman’s mother told the Court that when she had still been strong enough to do so, she had come to her parents’ house every day. She would take care of the family cat, would water seeds she had planted, and was trying to finish an art project for her grandmother. While she had sometimes said that she wanted to die, she showed interest when there was something that might offer hope of recovery. Her mother believed that she wanted help and said that her other family members all thought the proposed treatment should be carried out.

The Court accepted that the woman lacked capacity. As a result of her illness and the effects of starvation on her brain, she was affected by an impairment of her mind. In considering her best interests, the Court was careful not to assume too readily that what her mother had said about her likely wishes or feelings was so: it had to consider the possibility that what she said her daughter wanted or would want was inextricably bound up with her own wishes. However, aspects of the woman’s behaviour – such as her strong wish to be able to continue visiting her family and her interest in possible treatments – were not consistent with someone who held no hope for a future life. The Court observed that planting seeds and, more significantly, returning to water them and check on growth was entirely irreconcilable with someone with no interest in the future.

The Court was satisfied that, in all the circumstances of the most unusual and troubling case, it was in the woman’s best interests to undergo the proposed course of treatment. It accordingly made the declarations sought.