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End-of-life care in a case of severe anorexia nervosa and end-stage liver disease
  1. Martin Curtice1,2,
  2. Wasan Bajallan3,
  3. Caroline Winkle4
  1. 1Consultant in Old Age Psychiatry, Worcestershire Health and Care NHS Trust, New Haven, Princess of Wales Community Hospital, Bromsgrove, Worcestershire, UK
  2. 2ST5 in Old Age Psychiatry, Princess of Wales Community Hospital, Bromsgrove, Worcestershire, UK
  3. 3ST6 in Old Age Psychiatry, Coventry and Warwickshire Partnership Trust, Caludon Centre, Coventry, UK
  4. 4Dudley and Walsall Mental Health Partnership NHS Trust, Bloxwich Hospital, Walsall, UK
  1. Correspondence to Dr Martin Curtice, martincurtice{at}nhs.net

Abstract

This article reviews a Court of Protection case involving a woman, Ms X, with two severe medical conditions: anorexia nervosa and end-stage liver cirrhosis due to alcohol dependence. Each of these conditions alone warranted end-of-life care planning. When combined, they provided a far more unique and complex presentation because of the way they were intertwined. Ms X's life was in imminent danger. The Court implemented methodically the principles of the Mental Capacity Act 2005. Ms X was assessed as lacking capacity to make decisions in relation to treatment for her anorexia. However, she retained capacity to make decisions regarding treatment for her liver disease and the continued harmful use of alcohol. The Court ruled that it was not in Ms X's best interests to be subject to further compulsory treatment for her anorexia, even though this may have prolonged her life. It was also in her best interests and lawful not to provide nutrition and hydration with which she did not comply.

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