Sunday, June 17, 2012

Force Feeding - Thoughts in Hindsight.

I was well taken aback when a casual tweet about a High Court Judge deciding in favour of force feeding an anorexic sufferer from Wales became front page news. Had not expected anyone to take the slightest notice. While I had no wish to take the matter further, I did  agree to join a phone-in discussion on Radio 5 last night. Also spent part of yesterday just reflecting on what I'd said. I usually find that my considered thoughts are similar to my first instinct.  I still think the judge made the wrong decision - even though most of those who have engaged with me in discussion don't seem to agree. Don't suppose you're interested but just in case, lets consider the way my thought processes have gone.

The Judge tells us he considered the 32 yr old Welsh woman to be intelligent, articulate and above all else did not want to eat food or be force fed. This was not in doubt. However, along with much expert opinion, he considers anorexia a mental illness, and as such the patient should be regarded as not competent to decide. So he did not accept her wishes.

The Judge tells us that those closest to the woman (presumably family) supported her wishes. She was in hospital and we are told that those caring for her also support her wishes. We are not told whether this included doctors, but we do know the case was taken to the High Court by the local authority, rather than the local health board. The Judge decided not to accept any of this - perhaps because the terrible pressures on all of these people may have influenced their judgement.

The Judge also tells us that the woman was gravely ill, and only has a small chance of survival.  He put it at 20%. His reasoning suggests that even at 1% he would have made the same decision. That 1% could be 100% for the woman if she were to recover.

I simply cannot see any other way to interpret this judgement except that force feeding should be available as a form of treatment in all cases of anorexia. This must also the logical conclusion of those who have disagreed with my opinion on this particular case.

Two other points I'd like to make. Firstly the Judge has presented his judgement in a very high profile way, which will inevitably lead to it being seen as a 'precedent' which will influence managers and other decision makers in the health care system. Its not unreasonable to suppose this was the Judge's intention.

And finally, most people with whom I've spoken tell me of the shockingly patchy service that anorexia sufferers can expect - particularly across Wales. There is clearly need for much improvement. But what will be now be the response of decision makers. I fear it will now be to see force feeding as the 'standard' procedure. I have a fair idea how the minds of officials work. This decision may well lead to a poorer service for anorexia sufferers.

I am not opposed to 'force feeding' where there is a reasonable expectation that it will help a sufferer. In this case, the background to the case suggested to me that if ever there was a situation where the views of the patient should have been respected, and she should have been allowed to die with dignity this was it. That's why I disagreed with the Judge.


Roy Norris said...


Thanks for your additional comments.

I still cannot see the logic of your reasoning given your views about assisted suicide.

You have still not addressed what to me is the key issue. Why is it acceptable to let a person whose mental capacity is, at best, subject to doubt to die, when there are measures available which may save their life? As you oppose assisted suicide for a person whose mental capacity is not so doubted your position leaves me with a very uncomfortable feeling.

Anonymous said...

"he considers anorexia a mental illness"

It *is* a mental illness, there is no ambiguity (ICD-10 F50.0).

Do you not consider it to be mental illness - if so, why?