NHS refuses to force-feed anorexic woman at ‘imminent' risk of death

Telegraph

20-03-2025

The NHS has refused to force-feed a 25-year-old anorexic woman who is at 'imminent' risk of death, The Telegraph can reveal.
'Patricia', as she is called under a court order, weighs 19kg with a body mass index (BMI) of 7.3 – and is so malnourished that she has not walked for two years.
In 2023, a judge ruled that Patricia had 'autonomy' to refuse nasogastric (NG) tube-feeding.
Her family then applied to the Court of Protection on March 1 this year for an order that would allow doctors to force-feed her without her consent.
Oliver Lewis, a barrister representing the family pro bono, told the court: 'It is far too early to let this 25-year-old woman die when medical treatment is available that could prevent her death.'
But on Wednesday, the NHS bodies overseeing her care told the court they could not offer NG feeding without her consent.
A judge therefore ruled that, for now, 'the only viable path forward' is for Patricia to 'remain on a voluntary treatment plan'.
'Patricia in a Catch-22 position'
Norfolk and Norwich University Hospital NHS Trust (NNUH), where she is being monitored, and Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), which provides mental health care, argued that force-feeding Patricia would be futile. This stance goes against NHS guidelines stating anorexia is not a terminal illness and should be treated.
NNUH told Mrs Justice Arbuthnot that it would not consider initiating tube feeding against Patricia's will unless a specialist eating disorder unit agreed to admit her afterwards.
The Official Solicitor pointed out that this put Patricia in an 'invidious' position, 'a Catch-22', as no unit will commit to this before NNUH stabilises her.
The two trusts can now be named after The Telegraph successfully challenged a reporting restriction. NHS Norfolk and Waveney Integrated Care Board (ICB), which commissions Patricia's care, can also be identified.
With no alternative, Mrs Justice Arbuthnot was left having to choose between what the Official Solicitor described as 'the least worst of awful options': do nothing, or continue voluntary treatment, which has so far not worked.
The judge sympathised with NNUH's position that tube-feeding 'shouldn't really start until there is a whole exit strategy', but acknowledged the family's point that the voluntary care she was left to recommend will likely see Patricia 'continuing to decline'.
The family sought a court order under the Mental Capacity Act (MCA) to compel Patricia to receive life-saving eating disorder treatment, including NG feeding. This would have overturned a 2023 Court of Protection ruling by Mr Justice Moor, who upheld her 'autonomy' to refuse treatment after CPFT clinicians deemed her anorexia 'untreatable'.
Mr Justice Moor, who has since retired from the High Court bench, said at the time that she was so frail that she would likely die within days.
'Continuation of status quo will be fatal'
But Patricia, who has always insisted she wants to live, defied expectations. She has survived 18 months despite getting just eight days of eating disorder treatment in that time.
On Thursday, Patricia's aunt condemned NNUH, CPFT, and the ICB for not agreeing to provide the life-saving intervention under compulsion, calling it 'unconscionable'. The outcome of Wednesday's hearing, she warned, was 'a continuation of the status quo that will be fatal'.
Katie Gollop KC, representing NNUH, told the court that her client had been put in a 'very difficult' position, and that it would be 'unethical' to re-feed Patricia until a specialist eating disorder unit was available to move her after.
She said NNUH had 'believed that [Patricia] would not be alive in March 2025', but stressed that 'nobody wants Patricia to die'.
'None of the NHS bodies are motivated by bringing about her death,' Ms Gollop added.
Sophia Roper KC, CPFT's counsel, said that while the 'tempting' position is 'to do whatever it takes to keep her alive', it did not follow that this was the right thing to do.
On Thursday, Patricia's aunt told The Telegraph her niece was 'on the brink of death' and urged the NHS to reverse its stance and force-feed Patrica, even if there is no plan for what happens afterwards.
She said: 'All NNUH needs to do is offer, today, to tube-feed her against her will for a few weeks until she is stable enough for transfer to a specialist unit.
'We believe a specialist unit would accept her once she has gained just enough weight to pull her back from the brink of death. If NNUH continues to refuse to urgently begin this life-saving intervention, will another hospital step forward?'
She added that the judge's suggestion that the trust might still intervene 'if she is actively dying' made no sense.
'Patricia is actively dying right now. She is starving to death. Yet NNUH still refuses to offer the one thing that could save her – the ability for doctors to NG feed her against her will,' she said.
'Patricia has goals and dreams'
Mr Lewis argued that in no previous eating disorder case has the Court of Protection ever 'permitted death in a case where P – here, [Patricia] – so strongly does not want to die'.
'Patricia has dreams and aspirations and goals: she wants to walk again, to go back to studying, and she wants to go on holiday to Bhutan with her aunt,' he said.
The family's written submissions include increasingly panicked WhatsApp messages from Patricia in recent weeks, pleading for help.
In a message to her aunt on February 28, she wrote: 'I don't want to die… I want to walk up mountains. I want to swim in the sea. I want cuddles and kisses. I want to play and have fun.
'I'm so so scared. I'm terrified. Please help me more. WE [sic] haven't got much time to play with. I'll never walk if we don't sort things now.'