A 19-year-old woman who had a “very complex condition” which included a “severe eating disorder” has died two months after a judge ruled that doctors could lawfully stop providing her with “artificial nutrition and hydration”.
Sir Jonathan Cohen had made the ruling in May at a hearing in the Court of Protection, in London, where judges consider issues relating to people who might lack the mental capacity to take decisions for themselves.
The judge announced the teenager’s death in a written ruling on Friday and described the case as “tragic and deeply distressing”.
He has not identified the teenager in his ruling but referred to her by the initials BG.
Lawyers representing a mental health trust responsible for the teenager’s care had applied for orders “permitting the ceasing of artificial nutrition and hydration”.
The application had been supported by the teenager, her parents and a psychiatrist.
He said experts involved had agreed that “nothing more” could be done to help the teenager.
Sir Jonathan, who is based in London and also oversees hearings in the Family Division of the High Court, said he had been asked to make as “grave” a decision as can be made.
“This case is quite unlike any that I have come across,” he said in the ruling.
“The distinction lies above all in the fact of the agreement between experts that there is nothing more that can be done to help BG.
“The law contains the strong presumption that all steps will be taken to preserve human life unless the circumstances are exceptional.
“However, the principle is not absolute…”
The judge added: “To be asked to make an order which will be likely to lead to the death of a sentient, highly intelligent and thoughtful individual who, if otherwise able and minded, might accept treatment which could assist her is as grave a decision as can be made.”
He went on: “Simply because all the evidence points one way does not extinguish the burden.
“But, in the tragic and deeply distressing circumstances of this case, I am in no doubt that it is in BG’s best interests that I made the various declarations.”
The teenager had suffered mental health difficulties for more than a decade, said the judge.
She had been in hospital “almost continually” for three years.
“BG has made it completely clear over a prolonged period of time that she would wish to take her own decision and exercise her own autonomy over her body,” said the judge.
“Her very clear decision is that she wishes to be discharged from hospital, to go home and determine for herself, what if any nutrition or hydration she takes.
“This is not a sudden decision. It has been a long and deeply held wish of hers.
“I have had the obligation and privilege of reading her diary over many weeks.
“It is a harrowing read, setting out her suffering and how it should be resolved.”
Sir Jonathan said the teenager’s parents had provided written statements and her mother had given evidence at a hearing.
“I found what (her mother) had to say exceptionally thoughtful in these impossibly difficult circumstances,” said the judge.
“She and her husband believed it to be in BG’s best interests that her wishes should be respected, and treatment withdrawn.
“She emphasised that from BG’s point of view there were two points of paramount importance going forwards: she wants to have the absolute autonomy to be allowed to decide for herself what medical treatment she will accept or decline and the knowledge that her voice and her rights will be respected.
“(BG) is exhausted from being in so much intolerable pain for so long, and she would like to be sure that any palliative care plan guarantees pain relief such that she is not obliged to suffer further than absolutely unavoidable.”
Judges had initially barred any reporting of the case in a bid to protect the teenager.
Doctors and her parents had said any reporting would distress BG.
Sir Jonathan relaxed that ban in May, and allowed some detail to be reported, after a journalist argued that it would not be right for a decision of such gravity to be made in secret.
He disclosed more detail, in the ruling published on Friday, following the teenager’s death.