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In a highly unusual move, the High Court has sanctioned sedation and forcible tube feeding of a 16-year-old girl who weighed just five and a half stone and whose malnutrition was so critical that her body had started to shut down.
The girl, referred to as ‘A’, had been in an inpatient in a children’s hospital for almost a year where she vomited up to 30 times a day. Despite undergoing a large number of ‘highly intrusive’ tests, some of them under general anaesthetic, doctors had been able to find nothing physically wrong with her.
Both A and her ‘visibly exhausted’ mother were adamant that doctors must have missed something and vehemently objected to plans to feed her through a tube directly into her small intestine, bypassing her stomach. A had emailed the Court from her hospital bed to express her views.
However, a consultant gastroenterologist who had carried out a battery of tests on A had expressed ‘grave concerns’ that she might be suffering from ‘a form of fabricated and induced illness’. He had described the mother as a ‘potentially harmful parent’ and suggested that she might be ‘colluding’ with A.
The Court found that the tube feeding proposed was ‘perfectly safe’ and was the best way to save A’s life. Although there was no doubt that the mother wanted the best for her daughter, the Court observed, “The mother’s resistance to the only obvious course of treatment at a point where A has descended to a critical ‘red’ stage of malnourishment can only be interpreted as a dysfunctional understanding of her daughter’s needs, physically and emotionally.”
A’s own wishes and feelings were due respect; however, doctors were concerned about her apparent lack of understanding of how close she was to death and her ‘complete lack of fear or worry about her current health predicament’. In the circumstances, there was ‘compelling’ evidence in favour of the tube feeding proposed.
The Court directed that mother and daughter should be separated during the crucial first two weeks of tube feeding in order to give the procedure the greatest chance of success. A was also made a ward of court after the judge took the unusual step of visiting her personally in hospital to explain his decision. Doctors were granted leave to sedate her and to use ‘reasonable force’ in inserting the tube, although the Court hoped that neither course would prove necessary.