Anorexia Nervosa and the capacity to make decisions in an individual’s best interest

A recent decision in the Court of Protection saw a decision once again that a young woman suffering with Anorexia Nervosa lacked the capacity to make decisions about treatment relating to her condition

This case concerned ‘AB’, a woman who had been suffering for more than half her life with the ‘increasing and catastrophically debilitating effects of thisillness’. Her condition had reached a stage whereby the only treatment option that was available was nasogastric feeding. However, the nature of the treatment often requires either physical restraint or chemical sedation to ensure success, leading the court to decide that while she lacked capacity to make decisions regarding her treatment, it was not in her best interest to undergo further treatment such as this. The main reasoning was that it would be a very traumatic experience for AB, and instead her palliative care plan would be the better option when required. 

This case highlights a number of important points:

There are a number of contradictions within the law. There have been no cases in which an individual with anorexia has been found to have mental capacity regarding decisions relating to the treatment of Anorexia Nervosa. This is problematic, as there should not be presumptions that someone lacks capacity on the basis of a particular conditions. Ins2(3)of the Mental Capacity Act of 2005, it states that a lack of capacity cannot be established merely by reference to a condition or aspect of behaviour which might lead others to make an unjustified assumption about their capacity. Yet, in regards to anorexia, it is seen that the very nature of Anorexia Nervosa prevents the individual diagnosed from being able to make decisions around eating. As a result, it is seen that they will never be able to satisfy the functional test in s3 MCA, because as the nature of Anorexia prevents the individual from being able to weigh decisions connected with food effectively. 

This is highlighted in the caseA Local Authority v E, in which the parents make the following statement:

‘It seems strange to us that the only people who don’t seem to have the right to die when there is no further appropriate treatment available are those with an eating disorder.’

It does however demonstrate the importance of the idea that just because an individual lacks the mental capacity to make effective decisions, it doesn’t mean that treatment can be forced upon them. It must still be seen that the treatment is acting in the individual’s best interest. However, the concept of an individual’s ‘best interest’ is not defined in the Mental Capacity Act. It merely states that it cannot be made on the basis of age, appearance, a condition, or aspect of their behaviour which could lead to an unjust presumption. Whilst this is good in theory, what is decided as acting in someone’s best interest thus isn’t a secure or standardised decision, meaning different people could come to different conclusions, which may not be in the interest of the patient.  I would therefore argue a clearer definition on how to describe best interest is needed to protect the patient’s interest. 

In conclusion, I would argue that including Anorexia Nervosa within the current law is inherently problematic in that it will never have mental capacity to make their own decisions. I would thus argue that questions need to be asked whether this is really in the best interest of the people with suggested lack of mental capacity when this is considered in the light of the labels and stigma attached to this.

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