A New Jersey woman who has suffered from anorexia most of her life cannot be force-fed and should receive the palliative care she desires, a state superior court judge ruled yesterday. The case sheds light on the complicated nature of bodily autonomy.
The 29-year-old woman, known only as A.G., spent more than two years in a state-run psychiatric hospital and weighed between 60 and 69 pounds this year. In June, her appointed temporary guardian received a court order that she should be fed artificially at Morristown Medical Center. A.G. reached 90 pounds but suffered heart failure from refeeding syndrome and pulled out the tube herself. Her guardian requested that she be transferred to palliative care in October but the state Department of Human Services opposed it.
The state argued that her depression renders her unfit to make her own medical decisions and that no longer force-feeding her is sanctioned suicide; they want to treat her depression with an experimental course of ketamine. Her doctors testified that she’s been diagnosed with late terminal anorexia-nervosa and isn’t likely to recover. Her psychiatrist said that force-feeding would be “cruel and torturous at this point,” as she has the bone density of a 92-year-old and restraining her to insert a feeding tube through her nose and down her throat could break her bones. And, as her court-appointed lawyer argued, force-feeding would keep her alive but would not treat her anorexia.
A.G.’s mother testified that she and her husband did all they could to help treat her anorexia including admitting her to facilities, attending therapy with her, and managing her medications for more than ten years. A.G. was committed to a state psychiatric hospital in 2014 after she was found passed out in a hotel after overdosing on an antipsychotic drug and drinking alcohol.
In his two-hour-plus opinion, Morris County judge Paul Armstrong said A.G. has the mental capacity to deny food and that courts have consistently upheld the right of patients or their families to refuse lifesaving treatment. A.G. stated in court documents that she’s prepared to die and Armstrong said that in an interview she “expressed an unequivocal desire to accept palliative care as suggested by her treating physician and the bioethics committee at Morristown Medical Center.” He ordered her to be transferred to the center’s palliative care unit; it’s unclear if the state will appeal.
Medical ethicists who treat teens with anorexia have to weigh the competing principles of bodily autonomy and beneficence, or doing good, and Canada sometimes uses a principle called supported autonomy to save the lives of people with mental-health conditions. Such “compassionate interference” could help people regain autonomy by treating an illness that impairs their ability to make medical decisions, but in this case, the judge said A.G. was of sound mind: “This decision was made by A.G. with a clear understanding that death was or could be the possible outcome.”