Whose voice should be the loudest?

During the last few months l have been involved in two reported cases involving young women with a diagnosis of Anorexia Nervosa. In both cases, heard by different judges, declarations were made that ‘Patricia’ in three separate decisions (9 May 2023, 15 May 2023 and 2 October 2023 where l represented the Integrated Care Board) and ‘HC’ lacked the mental capacity to make relevant decisions at that time. In balancing the views of the professionals against those of the women, the court declared that their wishes and feelings should be paramount when determining what was in their best interests. In the case of Patricia, this was so even though "it probably meant that she would eventually die".

We all want those who are vulnerable to have their voice heard and news stories worry us when decisions are made that take away all control from a vulnerable person. Indeed, l wonder whether we are on the cusp of a ‘Winterbourne View’ exposé about the people currently subject to Deprivation of Liberty Safeguards behind closed doors in the community where they are cared for 24/7 by staff with little external oversight. According to the Family Court Statistics published at the end of July 2024, deprivation of liberty court application numbers hit record high, up 30% on the same period a year earlier.

However, for healthcare professionals who are trained to care and preserve life, respecting the wishes of those who have been deemed unable to make the relevant decisions, and watching them deteriorate as a result, is an incredibly difficult thing to do even when it has been determined by the court that it is in their best interests. This is not to doubt that the person struggling the most is the individual themselves.  

‘Patricia’ is the sixth eating disorder patient since 2020 who has been given the right to refuse life-saving treatment. I anticipate that the continuum we are on will continue, and the voices of the most vulnerable in our society will be heard in greater volume however difficult that may be for professionals who understandably want to ‘save’ everyone.