Severe and Enduring Anorexia Nervosa in the Court of Protection in England and Wales

Abstract

This article explores legal issues relating to the continuation of in-patient treatment for people with severe and enduring Anorexia Nervosa in circumstances where there are doubts as to treatment efficacy. In five recent cases, the Court of Protection in England and Wales has been asked to consider the capacity and best interests of patients with severe and enduring Anorexia Nervosa. Drawing upon international comparisons, this article outlines the clinical uncertainties associated with prognosis and treatment and evaluates legal assertions surrounding capacity and best interests. It is suggested that to ensure palliative management is based on need rather than diagnosis, and that capacity is decision- and not disease-specific, a closer alignment is required between the focus of any capacity and best interests assessments.

Three specific recommendations are put forward: Firstly the courts should adopt a patient-centred rather than clinician-centred approach to framing the decision that is subject to a capacity assessment. Secondly where a patient with Anorexia Nervosa lacks capacity, reliance on their stated treatment preferences must be balanced with their views and hopes regarding prognosis. The value of different treatment options should be assessed in this light. Thirdly given the clinical and ethical uncertainties regarding prognosis and appropriateness of treatment, there are dangers in relying on the same court-appointed expert in all cases.