Saturday 16 June 2012

Should Courts Ram Treatment Down Throats?

I must admit that I am somewhat peturbed by the ruling by Mr Justice Peter Jackson that a 32 year old patient suffering from anorexia nervosa who does not want treatmtent, and whose family support her decision, must be given treatment which amounts to force feeding, possibly for a considerable period, in order to preserve her life. I had assumed, when I heard the news, that the patient was unconscious or was not able to express a clear wish. However, reading the report of the case, this does not seem to be so. I do not want to get into the merits or demerits of the particular case - that is not appropriate - but I do want to say that the judge's decision has given me pause for thought. He appears to be arguing that the courts have grounds for becoming involved in an individual's treatment in order to save life, even when the individual concerned is opposed. Of course, the State already permits this in cases where doctors section patients and, no doubt, there are grey areas, here, when psychiatrists, patients and families disagree on whether there are sufficient grounds for sectioning a person and compelling them to have treament. However sectioning a person does not quite seem to equate with a ruling to force feed them. As far as I can tell, you would have to physically restrain someone two or three times a day in order to do this or repeatedly sedate them against their will and, if you were to do the latter you would hardly be helping to restore them to patterns of eating that would sustain a life that was to any degree 'normal'. Passing a naso-gastric tube on someone who is willing can be distressing enough; to hold someone down and do it against their will time and time again could be described as very cruel. One wonders whether the psychological trauma caused would militate against the patient ever recovering and, indeed, it would be a pretty dehumanising procedure for nursing and medical staff to have to undertake.

I've just been reading A.N. Wilson's After the Victorians; Arrow Books 2006. In the chapter The Accursed Power, he discusses the treatment of suffragettes by the Liberal government of the time. What is striking is that several members of the militant wing of the movement who had been imprisoned and were on hunger strike were straight-jacketed and force-fed on the order of the then Home Secretary (Winston Churchill), again, on the grounds that they were hysterical and did not know their own minds and that it was in their own best interests for the State to intervene to save them from themselves (not to mention the Liberal party's interests!) There is something rather disturbing about State or Courts (which certainly were in Churchcill's time and still are largely male) sanctioning this kind of treatment of women with all its overtones of physical abuse. When a person is sectioned it is usually for their own safety and so that they can have the best possible chance of being restored to health - it is for their demonstrable good. I cannot see that consigning a fully aware person suffering from anorexia to repeated interventions of a distressing nature is going to be anything other than very psychologically damaging - it might well be argued that it will work against their health or any chance of recovery that remains. Should the patient not recover, this will certainly not allow them a dignified or peaceful death.

I can see many of the arguments for intervention to preserve life, but I am uneasy about this decision to intervene in the treatment of an individual in ways that will undoubtedly cause a great deal of distress.

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