A Mental Health NHS Trust v BG [2022] EWCOP 26

Reserved judgment following declarations that it was in BG’s best interests for no further treatment and no hydration or nutrition against her wishes.

BG was 19 years old. Since an early age she had been very sensitive to events that others would take in their stride. She first came into contact with mental health services aged 8, had two courses of CBT, started self-harming at 14 and in 2018 was formally diagnosed with anorexia nervosa. Her medical treatment included 9 sessions of ECT that produced no improvement. When staff fed her under restraint she struggled against it and was obviously distressed. Although initially disputed, by the time of the hearing it was agreed that BG lacked capacity.

As Cohen J notes at [48] this case was quite unlike any that he had come across before because of the agreement between the experts [see 24-36] that there was nothing more to be done to help BG who had clear wishes that she did not wish to be fed or hydrated. Citing Airedale NHS Trust v Bland, Cohen J concludes at [50]

“To be asked to make an order which will be likely to lead to the death of a sentient, highly intelligent and thoughtful individual who, if otherwise able and minded, might accept treatment which could assist her is as grave a decision as can be made. It has of course weighed heavily for a long period with BG, her parents and Dr Z, and now me. Simply because all the evidence points one way does not extinguish the burden.  But, in the tragic and deeply distressing circumstances of this case, I am in no doubt that it is in BG’s best interests that I made the various declarations.”

A postscript adds BG died on 23rd July.

Read the judgment on Bailii