A tragic case in the UK Court of Protection illustrates some of the ethical issues involved in refusing burdensome treatment.
AB is a 28-year-old woman who has struggled with anorexia nervosa since she was 13. She now weighs about 26 kilograms and is so weak that she could easily die of starvation or a cardiac arrest.
At this stage the only way to save her life is naso-gastric tube feeding. But AB finds this abhorrent. She would have to be restrained or sedated during the procedure to keep her from ripping the tube out. “The only purpose of such an option would be to re-nourish AB's body to the point where she is well enough to engage in psychiatric or psychological therapies,” observes Mrs Justice Roberts in her decision.
“Because of the physical and psychological trauma which would be inflicted on this young woman were she to be subjected to a further trial of nasogastric feeding, both [her parents] and she are in agreement that she should not receive any further active treatment for her anorexia nervosa,” she writes.
What the judge had to determine was whether AB had the mental capacity to refuse further medical treatment which could save her life. She declared that AB was mentally competent.
This flows from the fundamental principle that a person who has capacity is entitled to decide for himself or herself whether or not to accept or decline medical treatment. Even treatment which has the potential to save life is subject to that absolute principle and basic human right once a court is satisfied that the person concerned has the capacity to make the decision. This fundamental right to choose is not limited to situations and decisions which others might regard as sensible. It matters not that the reasons for making the choice are "rational, irrational, unknown or even non-existent"
So, concluded Mrs Justice Roberts, forced feeding was not in AB’s best interests.
Michael Cook is editor of BioEdge
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