Under what circumstances can a patient detained under section 2 be force fed. A patient has withdrawn consent to be fed via NG feed. Is it legal to force feed.
Has the patient been judged to have capacity to withdraw consent ?
See this case and comment by Alex Ruck-Keene. It sets out the legal framework (I don’t think any that followed updated it) but each case is so very different as to the question of whether it SHOULD be done. https://www.mentalcapacitylawandpolicy.org.uk/the-mha-force-feeding-and-best-interests/
If the underlying question is “Can we force feed this s2 patient under the MHA” then I think the short answer is “Yes, if the force feeding is treatment for mental disorder.”
The main case seems to be B v Croydon Health Authority  Fam 133:
(1) Medical treatment for mental disorder under s63 includes treatment of the symptoms of the disorder (as well as the disorder itself) and includes a range of acts ancillary to the core treatment; (2) on the facts, nasogastric feeding was treatment ancillary to treatment for psychopathic disorder.
On that basis Ian Brady was force fed under the MHA for years, as his hunger strike was a manifestation or symptom of his personality disorder (R (Brady) v Dr Collins  EWHC 639 (Admin)) but the patient in An NHS Trust v Dr A  EWHC 2442 (COP) was not.
The long answer would involve considering what other powers exist and whether to use any power at all.
Patient has capacity. But the issue is if she is not eating then she likely to cause serious harm to herself. I presume it would be in her best interest to give NG feed. A consultant was of the view that this is part of treatment under section 2.
I would agree with Jonathan
Thank you for your helpful replies all.
On a related topic 17 years ago when i was a commissioner for a PCT, we had a sec3 patient in a private hospital with a diagnosis of Borderline PD and Anorexia. The patient had had a ten year history of being force fed . she was being physically restrained in order to administer force feeding resulting in physical bruising .
We felt the treatment was doing her no good at all and was contributing to her behaviours .
we sort legal advice , We were advised that the N.I.C.E guidelines indicated that if a treatment cost more than £30,000 a year and no discernible improvement was observable after 2 years it should be discontinued.
Accordingly we advised the hospital that we would no longer fund this treatment. The Consultant protested that as the patient was sectioned we could not do this.
We responded that we were only legally bound to fund treatment that could demonstrate some beneficial effects.
The patient did not starve to death instead the confrontational nature of the force feeding ceased to be a counter therapeutic issue .
Hi Jonathan. I would entirely agree with you about the legal authority- if its treatment for mental disorder. The Croydon case is the original case that clarified this.
There are many NHS Trusts now who know that Part IV MHA is available to them but they seek the views of the court over whether it would be appropriate for them NOT to use these powers ( where for example they believe it to be causing increased stress without any therapeutic benefit.)
There are therefore a range of cases that have gone to the Court of Protection but the question was whether s2 allowed nano gastric feeding and it does, if it is to treat a mental disorder.
capacitated or not
good example here of the could vs should power to treat granted by S63. This is not about force feeding, but about how it can be OK not to provide treatment sometimes even when the legal autority exists to do so. In this particular case the judge said it would be an abuse of power to force treatment. But remember- all cases are fact specific:
Nottinghamshire Healthcare NHS Trust v RC  EWHC 1317 (COP),  MHLO 22 - Mental Health Law Online