Case Law Update – Mental Capacity Act 2005
Apr 18 2024
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In this case, the Court of Protection concluded that AB, a woman with chronic and severe anorexia nervosa, lacked capacity to make decisions about treatment for anorexia nervosa, and that it was in her best interests not to receive any further active treatment for anorexia nervosa.
This case contains useful guidance for practitioners, healthcare providers and commissioners on the Court of Protection’s approach to complex assessments of capacity.
Practitioners, healthcare providers and commissioners should be mindful that:
For further information about this case, please contact Melanie Lothbrok.
You can read the full case summary below.
An application was brought by the Trust to the Court of Protection for declarations that AB lacked capacity to make decisions about treatment for anorexia nervosa and that it was in AB’s best interests not to receive any further active treatment for anorexia nervosa.
Mrs Justice Roberts concluded that AB lacked capacity to make decisions regarding treatment for anorexia nervosa, specifically nasogastric feeding, on grounds that her anorexia nervosa (and compulsive desire to avoid weight gain at all costs) prevented her from using, weighing and balancing the relevant information. It was considered that her anorexia nervosa impaired her ability to accept any treatment which would allow her to avoid death by starvation or associated causes, in the context that AB wished not to die and to continue living.
However, Mrs Justice Roberts concluded that despite the potentially life-threatening consequences of further weight loss, it was not in AB’s best interests to receive nasogastric feeding against her will or under sedation. It was accepted that this would be distressing and traumatic for AB, and would likely be futile and precipitate her death in any event. The Trust’s proposed palliative care plan was endorsed.
This application concerns AB, a 28-year-old woman with a long standing history of chronic and severe anorexia nervosa. AB had had 11 previous hospital admissions including the use of restraint and forcible nasogastric feeding, which she were a source of significant trauma for her. Due to AB’s extremely low weight and fragility, she was at serious risk of death. AB accepted and understood that her life was at risk and expressed the desire to continue to live and not to die.
Due to AB’s advanced state of deterioration, forcible nasogastric feeding would be the only treatment option available for her. However, it was agreed by AB, AB’s treating clinicians and AB’s family that nasogastric feeding against her will using physical restraint or chemical sedation would not be in AB’s best interests, and would be physically and psychologically traumatic for her.
The Trust brought an application for declarations that AB lacked capacity to make decisions about treatment for anorexia nervosa and that it was in AB’s best interests not to receive any further active treatment for anorexia nervosa (namely nasogastric feeding).
The Trust gave evidence that a further hospital admission would be required for nasogastric feeding, but this was not likely to be successful unless AB was prepared to engage. AB had been unable to demonstrate any weight gain over the past years. The Trust considered that there was no prospect of AB recovering from anorexia nervosa and the focus should now be on giving her the best quality of life in the community, with the support of her close and loving family, and regular outpatient input. A palliative care and support plan was proposed by the Trust.
The Trust considered that AB had litigation capacity and capacity to make day to day decisions. However, the Trust considered that AB lacked capacity to make decisions concerning treatment options for anorexia nervosa. It was accepted that she understood the risks and consequences of what would happen if she continued to lose weight. However, it was submitted that AB’s anorexia nervosa and desire to avoid weight gain at all costs prevented her from using and weighing the relevant information – namely the importance of food intake to sustain her life.