“Patricia”, as she is called under a court order, weighs 19kg with a body mass index (BMI) of 7.3. She is so malnourished she has not walked for two years.
In 2023, a judge ruled Patricia had “autonomy” to refuse nasogastric (NG) tube feeding.
Her family then applied to the Court of Protection this month for an order that would allow doctors to force-feed her without her consent.
Oliver Lewis, a barrister representing the family pro bono, told the court: “It is far too early to let this 25-year-old woman die when medical treatment is available that could prevent her death.”
But on Thursday, the NHS bodies overseeing her care told the court they could not offer NG feeding without her consent.
A judge therefore ruled that, for now, “the only viable path forward” is for Patricia to “remain on a voluntary treatment plan”.
Norfolk and Norwich University Hospital NHS Trust (NNUH), where she is being monitored, and Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), which provides mental health care, argued that force-feeding Patricia would be futile. This stance goes against NHS guidelines stating anorexia is not a terminal illness and should be treated.
NNUH told Justice Arbuthnot that it would not consider initiating tube feeding against Patricia’s will unless a specialist eating disorder unit agreed to admit her afterwards.
The Official Solicitor pointed out that this put Patricia in an “invidious” position, “a Catch-22”, as no unit would commit to this before NNUH stabilised her.
The two trusts can now be named after the Telegraph successfully challenged a reporting restriction. NHS Norfolk and Waveney Integrated Care Board (ICB), which commissions Patricia’s care, can also be identified.
With no alternative, Justice Arbuthnot was left having to choose between what the Official Solicitor described as “the least-worst of awful options”: do nothing or continue voluntary treatment, which has so far not worked.
The judge sympathised with NNUH’s position that tube-feeding “shouldn’t really start until there is a whole exit strategy”, but acknowledged the family’s point that the voluntary care she was left to recommend will likely see Patricia “continuing to decline”.
The family sought a court order under the Mental Capacity Act to compel Patricia to receive life-saving eating disorder treatment, including NG feeding. This would have overturned a 2023 Court of Protection ruling by Justice Moor, who upheld her “autonomy” to refuse treatment after CPFT clinicians deemed her anorexia “untreatable”.
Justice Moor, who has since retired from the High Court bench, said at the time that she was so frail that she would likely die within days.
The family sought a court order to compel Patricia to receive life-saving treatment. Photo / Getty Images
‘Continuation of status quo will be fatal’
But Patricia, who has always insisted she wants to live, defied expectations. She has survived 18 months despite getting eight days of eating disorder treatment in that time.
Patricia’s aunt condemned NNUH, CPFT and the ICB for not agreeing to provide the life-saving intervention under compulsion, calling it “unconscionable”. The outcome of Thursday’s hearing, she warned, was “a continuation of the status quo that will be fatal”.
Katie Gollop KC, representing NNUH, told the court that her client had been put in a “very difficult” position and that it would be “unethical” to re-feed Patricia until a specialist eating disorder unit was available to move her after.
She said NNUH had “believed that [Patricia] would not be alive in March 2025”, but stressed that “nobody wants Patricia to die”.
“None of the NHS bodies are motivated by bringing about her death,” Gollop added.
Sophia Roper KC, CPFT’s counsel, said that while the “tempting” position was “to do whatever it takes to keep her alive”, it did not follow that this was the right thing to do.
On Thursday, Patricia’s aunt told the Telegraph her niece was “on the brink of death” and urged the NHS to reverse its stance and force-feed Patricia, even if there is no plan for what happens afterwards.
She said: “All NNUH needs to do is offer, today, to tube-feed her against her will for a few weeks until she is stable enough for transfer to a specialist unit.
“We believe a specialist unit would accept her once she has gained just enough weight to pull her back from the brink of death. If NNUH continues to refuse to urgently begin this life-saving intervention, will another hospital step forward?”
She added that the judge’s suggestion that the trust might still intervene “if she is actively dying” made no sense.
“Patricia is actively dying right now. She is starving to death. Yet NNUH still refuses to offer the one thing that could save her — the ability for doctors to NG feed her against her will,” she said.
‘Patricia has goals and dreams’
Lewis argued that in no previous eating disorder case has the Court of Protection ever “permitted death in a case where P — here, [Patricia] — so strongly does not want to die”.
“Patricia has dreams and aspirations and goals: she wants to walk again, to go back to studying, and she wants to go on holiday to Bhutan with her aunt,” he said.
The family’s written submissions include increasingly panicked WhatsApp messages from Patricia in recent weeks, pleading for help.
In a message to her aunt on February 28, she wrote: “I don’t want to die… I want to walk up mountains. I want to swim in the sea. I want cuddles and kisses. I want to play and have fun.
“I’m so so scared. I’m terrified. Please help me more. WE [sic] haven’t got much time to play with. I’ll never walk if we don’t sort things now.”
Increasingly panicked WhatsApp messages from Patricia have been submitted as evidence. Photo / 123RF
Lewis explained that Patricia is so severely ill with anorexia that she “cannot distinguish between broader wishes [‘I want to live’] and the narrower ones regarding life-saving interventions [‘I don’t want NG feeding’]”.
He explained she must urgently be treated under the MCA. “The alternative is that she will die while the NHS bodies continue to pass the buck,” he said. In court, he remarked: “The family finds it strange that the NHS has the chance to save her life but is refusing to take it.”
Lewis pointed out Patricia had never been re-fed to a healthy weight since becoming unwell at age 11, that she had rarely received NG feeding, and that the last time she was given it — briefly in 2022 — she immediately improved.
After just a week, she emailed her psychiatrist: “I’m feeling so, so positive about things moving forward. This is a brand new start for me, and I don’t know why on earth I didn’t just have the NG when I first came in! Wish I could go back in time, but I can’t. So it’s now onwards and upwards!”.
‘It is easy to mischaracterise this as the NHS getting in the way’
The court heard no explanation why doctors looking after Patricia in the past had abandoned refeeding treatment, especially when she was so eager to continue.
Sophia Roper KC, acting for CPFT, told the court it is “a mischaracterisation to say the consultants weren’t trying hard enough, or gave up”.
She added: “It is easy to mischaracterise this as all the NHS bodies getting in the way, but the reality is that a SEDU [specialist eating disorder unit] needs to know what is being proposed”.
The family’s position is supported by Parishil Patel KC, the Official Solicitor’s barrister appointed to represent Patricia’s best interests in court.
Patel submitted that the original Court of Protection ruling placed “in hindsight, an impossible burden” on Patricia.
He told Gollop that he was “sorry that NHS bodies feel unfairly criticised”, but said: “The context is that NHS representatives are talking about a young woman whose death is certain if the status quo remains.
“She has defied expectations, but the fact that her death is imminent is not in dispute.”
A further hearing has been scheduled for April 8, but Patel warned that the Official Solicitor has “very real concerns she will not make it to that hearing”.
