W (Medical Treatment: Anorexia), Re

Factual and Procedural Background

The Plaintiff, a 28-year-old woman referred to as W, has suffered from a severe and enduring eating disorder, anorexia nervosa, for approximately 20 years. Her condition has resulted in significant physical, social, and psychological consequences, including a critically low body weight and BMI. Despite multiple inpatient admissions totaling around 10 years across various specialist units and psychiatric wards, W has shown minimal enduring progress. Her current admission has lasted two years, during which she continues to lose weight at a dangerous rate, weighing less than 30 kg with a BMI of 12.6, placing her at imminent risk of death.

Due to the urgency of W's condition, the local Health Board initiated proceedings in the Court of Protection on 3 February. Directions were given on 10 February, and a hearing was held on 24-26 February. The court considered extensive medical reports, statements from W and her family, and oral evidence from treating psychiatrists and an independent psychiatrist instructed by the Official Solicitor. The court also engaged directly with W via video-link.

The central issue was the appropriate care plan for W, given her lack of capacity to make decisions about her eating disorder. The Health Board proposed discharging W into the community with a comprehensive support package, a plan that, while counterintuitive given her severe condition, was supported unanimously by medical professionals and aligned in part with W's own wishes.

Legal Issues Presented

1. Does W have the capacity to make decisions about the care and treatment of her anorexia nervosa?
2. If W lacks capacity, what decision is in her best interests concerning treatment and care?
3. Whether forced treatment, including feeding under sedation, is appropriate or justified in W's case.
4. Whether discharge from inpatient care into the community with support is preferable to continued hospitalization.

Arguments of the Parties

Health Board's Arguments

• The Health Board proposed two options: re-feeding W under sedation or discharging her into the community with a well-planned support package.
• The sedation and forced feeding proposal was abandoned due to ethical concerns, W's objections, lack of clinical availability, and improbability of sustainable recovery.
• The preferred option is discharge into the community, recognizing that inpatient treatment has not been effective and may not prolong life.
• Coercive treatment is no longer appropriate given W's long history and lack of progress.

Official Solicitor's Arguments

• The Official Solicitor, guided by expert psychiatrist Dr Glover, supports the Health Board's community discharge plan as being in W's best interests.
• The Official Solicitor emphasizes W's lack of capacity regarding her eating disorder treatment decisions.

W's Position

• W expressed a strong desire to make her own decisions and opposed enforced treatment.
• She wishes to be discharged home with support, believing she could manage her condition better outside hospital.
• W acknowledged the risks involved but preferred a collaborative plan including the possibility of short re-admission if necessary.
• She perceives anorexia as a way of life with addictive elements, complicating recovery.

Family's Position

• W's mother and sister strongly support W and have been deeply involved in her care.
• They are apprehensive about discharge but tend to support a short preparatory period before discharge.
• The family emphasizes the emotional challenges and risks but shares hope for the least detrimental option.

Table of Precedents Cited

Court's Reasoning and Analysis

The court began by recognizing the severe and enduring nature of W’s anorexia nervosa and the substantial physical, psychological, and social harms it causes. It accepted the unanimous medical view that W lacks capacity to make decisions about treatment of her eating disorder, though she retains capacity for other decisions.

Applying the Mental Capacity Act 2005 and relevant human rights principles, the court considered W’s best interests holistically, including her wishes, feelings, beliefs, and values, alongside medical evidence and the views of her family and treating professionals.

The court rejected the proposal for forced feeding under sedation due to ethical concerns, impracticality, and lack of clinical support. It also dismissed the prospect of further inpatient treatment as futile and potentially harmful, noting the pattern of repeated hospitalizations without lasting improvement and the negative impact of institutionalization on W’s autonomy and quality of life.

The court found that continuing inpatient care would not prolong W’s life more effectively than community discharge and that coercion was no longer justified. It accepted the Health Board’s plan for immediate discharge with a comprehensive community support package as the least worst option, consistent with W’s own wishes to regain some control and decision-making capacity.

The court emphasized that this decision does not represent abandonment; rather, it reflects a reasoned judgment that current treatment is not beneficial. The Health Board remains under a duty to provide promised community services, and the court acknowledged that if W’s condition changes significantly, reassessment and possible readmission could be considered.

Holding and Implications

The court APPROVED the Health Board’s plan to discharge W from inpatient care into the community with a carefully structured support package.

This decision acknowledges that, despite the grave risks, continued inpatient treatment is not in W’s best interests given the lack of efficacy and the adverse effects of institutionalization. The ruling directly affects the parties by authorizing the proposed discharge and community care plan but does not establish new legal precedent beyond the application of established principles to the facts of this case.