Too much or not enough? An analysis of best interests assessments for patients with anorexia nervosa

Thesis

In best interests assessments for patients with anorexia nervosa, judges face a complicated combination of ethical, medical, and legal considerations. This thesis dissects the question at the heart of that quandary: is it in the best interests of a patient with anorexia nervosa to withdraw compulsory treatment, including life-sustaining nutrition? Specifically, this research examines why that question is so difficult to answer. Using analogical case analysis, a critical framework based on theories of autonomy, and clinical studies, the project explains the Court of Protection’s general approach to best interests assessments, followed by an analysis of its approach to cases concerning anorexia nervosa patients. This leads to the identification of two confounding factors; that is, two factors which make it impossible to arrive at a legally, morally, and medically satisfying answer to the identified question. The first is the dilemma of autonomy. The potential for anorexia nervosa patients to autonomously refuse medical treatment—despite their lack of autonomy in relation to decisions about food—forces the judge to decide between prolonging the patient’s life at the cost of overriding her autonomy, or respecting her autonomy at the cost of her life. The second is the nature of compulsory treatment for anorexia nervosa. A hallmark of anorexia nervosa is patients’ intense need for control. Given that compulsory feeding entails complete removal of control over the body and a severe infringement of the right to bodily integrity, the treatment is precisely the thing that harms anorexia nervosa patients. Thus, judges must decide between authorising the patient’s death, or authorising and perpetuating suffering through treatment. In this way, the two confounding factors place judges in an invidious position. They create a conundrum such that there is no decision that can be deemed definitively ‘correct’.

Authors: White, S

• DOI: 10.5287/ora-wvqyzx8wj
• Type of award: MPhil
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: best interests assessments; Mental Capacity Act 2005; anorexia nervosa
• Subjects: Medical jurisprudence; Medical laws and legislation