Severe and enduring Anorexia Nervosa in the England and Wales Court of Protection.

Abstract

This article explores legal issues relating to the continuation of in-patient treatment for some patients with severe Anorexia Nervosa, in circumstances where there are doubts as to whether such treatment would be effective. 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 on international comparisons, this article outlines clinical uncertainties over prognosis and treatment in light of which legal assertions of capacity and best interests are evaluated. To ensure that 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 the capacity and the best interests assessments. Three specific recommendations are put forward: (1) The courts should take a patient-centred rather than clinician-centred approach to framing the decision that is subject to a capacity assessment. (2) 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. (3) Given clinical and ethical uncertainty on prognosis and appropriateness of treatment, there are dangers in relying on the same court-appointed expert in all cases.