Anorexic suicidal woman to be force fed

From the BBC

Justice Peter Jackson has ordered that a 32-year old anorexic woman from Wales be force fed to save her life. The woman, known only as "E", had previously expressed a desire to die through not eating and that she didn't want to be revived.

People close to "E", including her family and care team, expressed a belief that she should be allowed to die. Glyn Davies, Conservative MP for Montgomeryshire, supported this position on Twitter.

However the Judge belives that, although force feeding her would be intrusive and difficult, this course of action has a chance of saving her life and that he wouldn't have ordered it if he felt that it would be futile.

So, what do we think about this?

Personally, I'd like to say that I am a big supporter of euthanasia and allowing people the right to choose to die. I think that it's important to allow people with a terminal illness the right to avoid suffering or a loss of dignity.

However, in this case I think that the Judge has called it correctly for a number of reasons. Firstly, the woman in question is not suffering from an inescapably fatal illness; anorexia and the related mental illnesses in this case can be managed and even cured.

Secondly "E" is, as I just mentioned, clearly mentally ill and I think that it's important that anyone choosing to die has to be sound enough mind to make that choice in a rational manner. Suicidal behaviour in otherwise healthy adults isn't a sign that the person is of sound mind.

However, keeping her alive of course requires forced feeding. Obviously, this is a horrible and intrusive procedure that in turn risks greatly undermining the dignity of the woman in the question.

edited 17th Jun '12 6:49:53 AM by TheBatPencil

Since the quote from the article is so long, maybe you should do a short summary of the situation in your OP? Just two sentences or so.

Sure thing.

Yeah tldri indeed.

Nice avatar by the way OP ♥_♥

I'm probably showing my ignorance here, but I assume those IV things they use in hospitals don't work in this kind of situation?

The correct response to this situation won't be easy to determine. Is staying alive more important than anything else? Or are we trying to minimize people's suffering, even if that might mean their death? Or is it a matter of being able to choose? And if so, who gets to make that choice?

The answers to those questions are what determine what the "right" decision is, but what makes it hard is that different people are going to have different answers to these questions. And it's not even a majority thing like most people agreeing that rape is bad.

If we had a consensus on this issue, we probably wouldn't even be having this discussion in the first place.

The judge made the right call. Allowing a mentally ill person to commit suicide, especially by such a slow and painful manner as starvation, is immoral. As the OP said, anorexia and depression are mental disorders that can be treated or even cured.

I think euthanasia can be acceptable in some cases, but this is not one of them.

edited 17th Jun '12 7:13:38 AM by Talby

Hm this is certainly a complex situation. Normally I'd say let people do stupid shit like starve themselves to death if they choose, but if they aren't mentally sound, and can be helped through treatment, then saving them is the right call.

The problem here is that she is very likely at a stage where she isn't in any state of mind to make a considered decision. Amongst long-term starvation's well documented symptoms is cognitive irregularity. Once her weight is up to safe levels and her brain has readjusted, there is no real saying what her decision would be. It has happened many times before with forced intervention when it comes to eating disorders. Sometimes, the patient thanks you: other times, they do not.

At least you can give them a chance to make a real choice about how to feel about it. Dead is a little late to give second chances.

I agree completely.

Not if you hook her up to an IV and give her nutrients that way.

If it were just her who wanted to die and her family and friends didn't all support her decision, I'd say the judge was right. But if all of her associates think it's her decision, I say let her.

That being said, who the fuck chooses starvation as a way to die? That sucks. That's right up there with "Cover myself with honey and let fire ants slowly devour me." as a shitty method of self-termination.

The thing is, she has a serious illness that, in the opinion of the doctors (and I know of no reason to doubt them) makes it impossible for her to make a free, conscious choice. Euthanasia is one of these cases in which I have not a clear opinion: I am opposed to it personally, but I don't think I have a right to attempt to force others. But, unless I am misreading something (that could be the case), this is not a matter of euthanasia.

This said, a random idea — it probably does not work for some reason, since otherwise I'm pretty sure that doctors would have tried it already, but I'd like to know what is the problem. We know that we can keep comatose people alive more or less indefinitely, by feeding them through IV: in a case such as this one, in which a person's mental illness is making it stressful for her to feed itself and is making her kill herself by undereating, why cannot we just put her under for a while while we feed her back to a healthy weight?

It seems to me that it would be less hard on her than force-feeding; and it would not solve her mental issues, obviously, but it would give the doctors some more time to work on them...

edited 17th Jun '12 12:22:55 PM by Carciofus

Yeah, I have no issue with active euthanasia but the guidelines need to be insanely strict and followed to the letter. This woman is not terminally ill or even beyond hope by any stretch of the definition and, as others have said, no one who is sane and capable of making rational decisions would choose to commit suicide by starvation. And anorexia, I believe anyway, is linked with conditions like depression anyway.

Its a sad case and it probably won't end well (and certainly not without a lot of pain) but sometimes people who are incredibly vulnerable need to have choices have and, yes, forced upon them for their own good. Usually these people are children but it also covers those who are acutely mentally ill. The judge clearly put a lot of thought into it and recognized that there was no good solution, at least in the short term, just that letting this woman die was the worst option.

The thing is, most anorexics don't see anorexia as a way to starve themselves or to commit suicide or something. They see it as their own way of life. There is the fact that it often can stem from an issue of control, so this could be a warped way of expressing that she wants control over her own life, including when it ceases.

And by-the-by, anorexia cannot be fully cured, but it can be put under control if the person going through it is willing to improve him or herself and wants to try to live without it. Unfortunately, in many cases, it does not get better, but there is always hope if the person wants to get better.

Huh, well the BC Supreme Court just allowed a case of euthanasia. But, the thing is, you can't lightly allow it. Everyone around her supporting her decision is a prerequisite but you still have to question whether they're forcing her into the situation because they don't want to help her or that she herself is not fit to make a decision in the first place. I haven't really looked at the case that closely but I would favour the judge's decision if he made it based on the thought that the victim here couldn't make that choice.

While I agree that feeding her is the right choice here, I must take exception to something in the opening post:

That is quite the Catch-22. Is what you're saying that every rational person has a right to choose to die, but any healthy person who chooses to die clearly isn't rational? Because that's how I'm reading it.

I think there's a difference between outright suicidal and choosing euthanasia. I mean, if you've had a long term terminal illness I sort of don't have a problem with it? But generally if you're terminally ill you've already considered all other options, provided that it hasn't deteriarated your mind along with your body. But suicidal people in general aren't in a sound state of mind. Certainly someone who's anorexic has a mental illness and needs to have the right decisions forced on them to get them to a rational state of mind.

Well, the problem with IVs is that she would just pull the IV out. Force-feeding can only really be stopped by her throwing up the food.

edited 19th Jun '12 1:59:34 AM by GameGuruGG

Unless you dope her up or restrain her.

That line of thinking doesn't hold water.

Any person who wants to end his/her life is by definition suicidal. If you want to die because you're old and very sick and having a lot of pain, and allow yourself to be killed under the label of euthanasia, at the end of the day it's still suicide. — If suicidal people in general aren't "in a sound state of mind", then euthanasia is always wrong.

The thing is that, at least in our present culture, any person expressing suicidal thoughts is almost sure to be diagnosed with a mental illness (usually depression). It's because suicidal thoughts in itself are considered signs of mental illness. So the argument "first cure them and then, when they're healthy and sound and in a rational state of mind, let them decide whether they still want to end their life" is a fallacy, because we tautologically assume that any person wanting to die (without an "understandable reason") is by definition not mentally sound. But what constitutes an "understandable reason" is highly subjective.

You all seem to forget that both anorexia and heavy depression are severe, painful diseases which cause a lot of suffering. These are conditions no less serious and life-dominating than, say, cancer. If you think that euthanasia is okay with "really heavy illnesses", then why not mental illnesses like anorexia or depression?

"Otherwise healthy person" isn't really a sensible criterion. Any ill person is "otherwise healthy", apart from his/her specific illness(es).

@Carciofus, the assumption that a serious illness makes it "impossible for [a person] to make a free, conscious choice" is completely arbitrary. As for "free": We are never completely free and always act within the confines of our situation and the facts of reality. As for "conscious": What makes you think that an anorexic, depressive, or any other seriously ill person is less 'conscious' than a healthy person?

@Rationalinsanity, you wrote: “no one who is sane and capable of making rational decisions would choose to commit suicide by starvation.” — It’s happened before, even with non-anorexics. Which way of suicide would a sane and rational person chose, in your opinion?

edited 17th Jun '12 3:42:43 PM by LordGro

But, altered states of mind due to e.g. prolonged starvation are well documented. It's not so much "mental illness" as "a known physiological effect".

Anorexics may never actually be "cured" (depending on your definition of "cured"), but with the right methods put in place, the condition can be well managed. If you are in a state where management systems either have not been put in place or, for various reasons, have broken down, isn't it right to try to establish them before death is sought? If you try several times, and still feel that your life is a burden, if you are in an upswing and take the decision, I don't see how a judge, or anybody else, could intervene, then. For a start, my family know my opinion on this, ahead of time. And, I've got it in writing.

But in a down-swing when it's pretty obvious that cognitive functions can and will be affected? I have CFS... I wouldn't trust myself during prolonged brain fog periods. I'd kick any judge that let me do something stupid like kill myself during one. However, should I get a prolonged but acute fibromyagic (that's the pain-that-isn't-pain- but-still-can-be-downright-agony) episode with no end in sight and no movement, I might well seek death. <shudders> I've had weeks of that, on and off. Were I to face years... yup: I'd try ending my life, thanks. And, I'd try my damnedest to prove it wasn't down to brain fog.

Her best bet is to get up to a weight, do some work to try to manage the condition and get people to agree she's on an upswing: then write her opinion in black and white about what she wants should she get back into that state while nobody can say she's cognitively impaired. <shrugs>

edited 17th Jun '12 3:53:44 PM by Euodiachloris

My two cents...

See, the way I read this is that she is not suicidal. She doesn't want to die. She just really does not want to eat anything, and she accepts that death will be a necessary consequence of that. If there were a way to not eat and still live, she would probably take that.

On the subject of IV feeding, well, I'm no expert but my understanding of it was that it isn't the best choice. If you don't eat for a long time, the cells of your gut literally die off. To maintain gut health, you need to have food physically inside your gut.

I don't know how that works with IV-maintaining people in comas, but that's what I was taught.

^

I assumed that's what they do with coma patients. I'm not an expert though. -shrug-

So get her enough nutrients to where she isn't suffering the effects of starvation, and if she still wants to die, let her do it.

I feel that if people want to buy the farm early, sound mind or not, it's still their decision. Though in her case if she really wanted to die, she would have found something that works a little quicker. Or perhaps found a good stretch of wilderness to just walk off into and never come back. That's one way I've considered dying if I ever really lost the will to live, just ruck as far as I can go until I collapse.

Should some chronically depressed people be allowed to commit suicide? I'm in favor of treating those who are easy to treat, but some cases of depression never go away (or recur frequently) even with treatment, and these sufferers are in very real pain.

Kind of threadhopping here, but, this is proof of why one should leave a manifesto or suicide note.

If this woman had some documentation saying, "Yes, I want to die from starvation, do not attempt to revive me", then, yeah, let her die.

My wife is a nurse and stands firmly behind the right to die. It's a big part of the dignity of life. If a person is (by whatever definition you believe) "free" in their life, then they should be free to choose how they die and when.

BUT

Unless there is prior documentation saying that they want to die, a medical professional is trained to ignore protestations of the patient and to save their life, as was illustrated by the individual that made the "starvation causes cognitive dissonance" argument.

Medical ethics aside If she is actively trying to kill her through starvation then the court has a legal obligation to stop her, attempting suicide is a crime at all.