Legal Aspects of End-of-Life Care in Severe Anorexia Nervosa

Anorexia nervosa has the highest mortality rate of any psychiatric illness. Its management can be complicated as people with the condition can resist efforts to enable them to eat and drink. Ethical, medico-legal and psychological issues need careful exploration when considering compulsory treatment. This article summarises the judgment from the High Court case of a 32-year-old woman, ‘E’, with severe anorexia nervosa, emotionally unstable personality disorder, alcohol and opiate dependence and physical complications of malnutrition. Her death was imminent and she was placed on an end-of-life care pathway. Despite two advance directives refusing life-sustaining treatment, and her parents’ skepticism about further intervention, the judge declared that it was lawful and in her best interests for her to be fed, forcibly if necessary. This unique and complex case was heavily dependent on the detailed application of the Mental Capacity Act 2005. Respect for personal independence was balanced against the right to life to make a decision about E’s best interests. Conflicts of interest: none