Mental Capacity Act, Anorexia Nervosa and the Choice Between Life‐Prolonging Treatment and Palliative Care: A NHS Foundation Trust v Ms X
| DOI | http://doi.org/10.1111/1468-2230.12147 |
| Date | 01 September 2015 |
| Published date | 01 September 2015 |
Mental Capacity Act, Anorexia Nervosa and the Choice
Between Life-Prolonging Treatment and Palliative Care:
A NHS Foundation Trust vMs X
Daniel Wei L. Wang*
The Court of Protection decided in A NHS Foundation Trust vMs X that an anorexia nervosa
patient lacked the capacity to refuse treatment for her eating disorder, but that it was not in her
best-interests to be subject to force-feeding to prolong her life. The Court, vindicating previous
judgments in similar cases, considered that the eating disorder rendered the patient incapable of
deciding on nutrition and, therefore, that she lacked the capacity to refuse treatment for anorexia
nervosa. This paper questions the narrow way in which the patient’s decision was characterised
by the Court in this and previous cases, which led to an application of the Mental Capacity Act
2005 that is incompatible with the UN Convention on the Rights of Persons with Disabilities
because, based on a diagnosis only, anorexia nervosa patients were denied the right to decide
where the balance lies between quality and duration of their own lives.
INTRODUCTION
The question brought for the decision of the Court of Protection (COP) in A
NHS Foundation Trust vMs X 1(X) was whether an anorexia nervosa patient
whose death was imminent due to her low weight had the decision-making
capacity to refuse nutrition. And, if she lacked capacity, then whether force-
feeding to prolong her life – a long, painful and invasive intervention – would
be in her best interests rather than just providing palliative care to allow an end
of life with the best possible quality given the circumstances.
In this decision the COP’s analysis focused mainly on the question of the
patient’s best interests. To resolve the issue of capacity the COP considered that
the anorexia nervosa rendered her incapable of making a decision about nutrition
and, therefore, she lacked the capacity to decide about treatment for her eating
disorder. This conclusion regarding the patient’s decision-making capacity,
which vindicates previous decisions of the COP in similar cases, practically
creates an absolute presumption that an anorexia nervosa patient lacks the
capacity to refuse aggressive intervention for her eating disorder.
The argument in this paper is that this presumption results from a narrow
characterisation of the decision to refuse treatment made by the patient. It was
seen by the COP as a decision about nutrition only, although it should rather be
seen as a choice for a shorter life with the best possible quality over a slightly
longer life with very low quality and a modest possibility of full recovery. This
presumption also led to an application of the Mental Capacity Act 2005 (MCA
*Queen Mary, University of London. The author is grateful to Ruth Fletcher and Fabio Oliveira for
comments on previous versions of this paper. The usual disclaimer applies.
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Daniel Wei L. Wang
© 2015 The Author. The Modern Law Review © 2015 The Modern Law Review Limited. 871(2015) 78(5) MLR 854–882
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