Court of Protection removes barriers for anorexic woman to receive life-saving treatment
London, 31 July 2025. Mrs Justice Arbuthnot has today handed down a judgment in the case of Patricia, reported as [2025] EWCOP 30 (T3). It is the first eating disorder case in the Court of Protection where the court has reversed a previous order that prevented access to life-saving treatment.
Patricia is a 25-year-old autistic woman who has had anorexia nervosa since she was 11. In 2023, Mr Justice Moor in the Court of Protection held that Patricia lacked capacity to make medical treatment decisions, but that it was not in her best interests to receive nasogastric feeding or other treatment for anorexia against her will. Moor J published three judgments (here, here and here).
However, Moor J’s approach led to no improvement. On the contrary, Patricia’s health worsened to the point that she was on the brink of death in early March 2025. Patricia’s parents and aunt asked Doughty Street Chambers’ barrister Oliver Lewis to draft an application to reverse the 2023 order, so that Patricia could access life-saving treatment, including nasogastric feeding against her will, which Patricia opposes. At the time of the application, Patricia was taking in very few calories and nutrients, had a very low weight (in line with Beat’s eating disorder media guidelines we are not publishing her weight) and was at imminent risk of death.
Across eight hearing days from March to May 2025, Mrs Justice Arbuthnot, sitting as a Judge of the Court of Protection, heard evidence from Patricia’s parents, as well as several psychiatrists, a psychologist and Patricia’s gastroenterologist. The medical witnesses highlighted the complexities of Patricia’s condition and the pros and cons of forced nasogastric feeding.
Dr Ali Ibrahim, a consultant psychiatrist, provided the family with a pro bono opinion, arguing that Patricia’s best interests to receive for compulsory treatment for anorexia leading to full weight restoration. He acknowledged the psychological distress forced treatment could cause, but provided the court with the evidence-base of outcomes in which people turn a corner and are later grateful for life-saving treatment they resisted at the time.
The court considered whether to revisit the 2023 declarations, weighing Patricia's autonomy against the risk of her imminent death. Oliver argued on behalf of the family that Moor J had interpreted autonomy in a subjectivist, thin sense and had missed Patricia’s values and beliefs. It was wrong to frame the best interests decision as a binary choice between Patricia’s wishes (autonomy) versus the family’s/professionals’ values (welfare). Patricia’s wishes and feelings, values and beliefs are more nuanced, and ought to be understood through the lenses of anorexia and autism. Permitting Patricia to dictate her treatment on a quasi-capacitous basis has resulted in clinicians having to Patricia wearing a “metaphysically-loaded straightjacket”.[1]
In her judgment, Mrs Justice Arbuthnot said, “I agreed with Mr Lewis when he said, echoing Dr Ibrahim’s observation, that by ‘respecting Particia’s autonomy, the court [in 2023] had permitted her anorexia to call the shots’.”
The court agreed with the family and the Official Solicitor that the approach of the previous judge had failed: Patricia’s condition had deteriorated, and she was unable to make decisions in her best interests due to her anorexia.
Today, Mrs Justice Arbuthnot reversed the 2023 order:
“Having considered the balance of harm, the imminence of death versus the harm which will be caused psychologically and emotionally by the lifting of the declarations, the balance is in favour of trying to save her life. The removal of the declarations will allow the clinicians to work out what is best for Patricia, without the restrictions that currently prevent this.”
During the hearings, the court heard poignant evidence from the family about how Patricia wants to live and fulfil her dreams. On 28 February 2025, she sent a text message to her aunt:
“I don’t want to die…I want to go on holiday, I want to walk up mountains. I want to swim in the sea. I want cuddles and kisses. I want to party and have fun.”
Today’s judgment gives Patricia a chance to achieve her dreams. She can be transferred to a Specialist Eating Disorder Unit for treatment under the Mental Health Act 1983.
Patricia’s mother, father and aunt renew their call for NHS services to step up and meet Patricia’s need:
“We have been waiting for over two months for a bed to become available in a specialist eating disorders unit, but have been told no bed is available anywhere in the UK. Now that the court has removed the legal block that prevented Patricia from making progress, we call on the East of England Provider Collaborative to redouble their efforts to identify a bed so that Patricia can get the treatment for anorexia she desperately needs.”
Patricia and her family have received support over the past year from Eat Breathe Thrive, an international charity that supports people affected by eating disorders. Chelsea Roff, the charity’s Executive Director, attended several hearings in Patricia’s case and today said:
“It is rare to hear anorexia discussed in court with the level of nuance and understanding Oliver brought to these proceedings. At the heart of this case is a young woman who has lived with a severe illness for many years, who is dearly loved by those around her, and who deserves treatment and care. This judgment will give hope to the many families who are still fighting for loved ones, and the many people with eating disorders who are still here, fighting for the treatment they need and deserve.”
Notes:
Oliver Lewis represented the family on a direct access and pro bono basis, spending over 150 hours on the case since March 2025. Specialist Court of Protection pupil Jordan Briggs provided Oliver with superb research assistance.
The case was reported on 20 March 2024 in The Telegraph: “NHS refuses to force-feed anorexic woman at ‘imminent’ risk of death” (read here). It was featured on BBC Radio 4’s The Today Programme on 22 March 2025 and BBC Radio 4’s Woman’s Hour on 2 April 2025 (listen here).
For more information about Doughty Street Chambers’ Court of Protection team, please contact practice manager Emily Norman.
[1] Camillia Kong, John Coggon and Michael Dunn, “Giving meaning to values in mental capacity law”, L.Q.R. 140, October 2024, 620, at 625.
