Force feeding not in anorexia patient's best interests - UK Human Rights Blog, (Northamptonshire Healthcare NHS Foundation Trust v AB [2020] EWCOP 40)

Force feeding not in anorexia patient's best interests - UK Human Rights...Patient suffering from extreme eating disorder found not to have capacity, but further gastro-nasal feeding was ...
One commentator on the Human Rights Blog  argues the case  had been about whether the patient had the mental capacity to decide against force-feeding..With respect, this kind of reducing matters to fine legal points in my eyes means removing substance and context from the case. Formally they may have been right. But what is Justice for if not decide real-life cases:The Trust would not have argued that the patient did not have capacity if it was not for the fact they, the Doctors, thought they knew what was best for the patient (in her best interest). It would be interesting to see whether the Judge did consider that these were Doctors who had been unable to treat  the patient with any success for years, and if so in what light:. Commonly, under prevalent psychiatric concepts the patient is seen as the problem and as resisting therapy. Increasingly, and rightly in my view, survivors of such treatment who found other means to get better, argue that instead of asking 'what's wrong with you' - the  question 'what happened to you' should be asked. In-depth psycho-social and cultural investigation would at least have the chance to enable the patient to see her stuckness as socially constructed.
While the Judgment may be preferred over the alternative in this case (which would have been to allow force-feeding) it seems to me, ultimately, the Judge may still have failed to address the causes and the context: The Trust, the doctors, in this case seem already far removed from thinking about the patient's best interest. Justice, perhaps with the help of expert witnesses, looking deeply at the reality of either application in this case might have contributed to reversing that, might have applied human wisdom:
The Doctors would not need to be force-fed, only encouraged to seek treatment  options the patient could agree on. Since it can be assumed that they have the capacity to do so, it seems to be negligent not to do so. I do not know what if any psycho-social interventions were tried in the case at hand. However, I deduct from the fact that the Doctors (and the Trust) arrived the view they did (about force-feeding being in the patient's best interest) and also from my own experience working with Psychiatrists and other medically oriented mental health professionals: Where the investigation how to help a human in their care does not cast a wide net reaching all their life circumstances and human reasons for those, the ethical roots of  do not reach deep enough to be nourished by the desire to truly support a valued independent life and vice versa. 
I have met one exception - a young female Doctor who maintained a deeply human approach even while the system in which she worked did not give her any tools to apply it. She, of course, too ended up feeding a system that worked against her. deepest intentions.

I wished I was more optimistic about what ca can achieve. I attended one local once on social care and the facilitators chosen (by whom?) were clearly afraid to be open and honest about critical issues as perceived by service users. I saw one trembling as she had to take notes. She was an NHS employee, if I remember. Let's hope I am wrong.

From what I have read about the risks for covid patients in ICU and on ventilators, I can't help wondering whether if those who cared for him had treated him like many other NHS patients, the Prime Minister  might have been less likely to have survived? But more importantly his look of utter bewilderment and exhaustion recently reminded me of the story I heard about Jacob Levy Moreno, the psychiatrist who developed Psychodrama. According to Moreno's own memories, he had been brought up by his mother to be slightly at risk of megalomania - until he played God in some children's game and - perhaps egged on - jumped from a wardrobe, in role. He broke his leg in the fall and - was cured from his former predicament. Boris Johnson appears not to have the opportunity to have his childhood dreams cut to size. The less than flattering report from one tutor at Eton does not appear to have had sufficient effect. Having been voted into office favoured by the voting system, he had no other option apparently than to create another scenario that could break more than his leg - not least because of the responsibility for a disastrous death rate from covid in the UK and a choice of advisor that more than distracts from his own personality issues perhaps. What a terrible learning curve for his subjects..  

 Looking forward to an online meeting this Thursday with international speakers. For one, it being advertised made me aware - I may be a retiree soon, but I can still play a role. Secondly, working in statutory services, in my fifties, as a locum senior social worker in my personal reflection meant a sort of reconciliation with the many ills of the world that had previously tended to depress me. Here I could do something, a core thing, for one person- and it changed my world.
The other thing it taught me, on a personal level was my understanding of the phrase 'let's agree to disagree' - a core of what had attracted me to come to Britain - was mine.  The Local Authority reps who found me me a bit too radical (even as they could not put their finger on it), not only ignored the professional guide lines for social workers which demand walking that tight rope - authority - advocacy, they genuinely could not relax into having differing views.  

Today I read on linkedin that NHS whistleblower Dr Chris Day has been granted a Hearing at the Court of Appeal to challenge the previous decision which was made without examination and cross-examination.  I am delighted for him. He rightly points out how much the NHS has spent on discrediting him.  You don't want me to work out what it could have been spent on. I take heart in the fact that nurses and doctors are currently speaking out about shortage of equipment,  Where accurate, I trust all this could well contribute to a development where the Public Interest Disclosure Act is no longer beind undermined. 

Prompted by another social worker's question on facebook, I am reflecting on what sees me through and I find a few sentences recently heard echoing in my mind. There is the former GCHQ translator Katharine Gun. Her experience is presented in the film Official Secrets: She did not stop the war in Irak but says she has no regrets, she would do it again 'because 'truth always matters' . There is Judge Claire Gilham who had to take the case for whistle-blower-protection to the Supreme Court after having raised concerns about local working conditions. She says: 'Ethically I have always known my point was right'. There is the late Pakistani Human Rights lawyer Asma Jahangir who said 'of course you are afraid, of course you cry - but that does not mean you stop'. Of course, only the latter was in a position where her life was at risk. And only Katharine Gun was imprisoned when accused of a breach of the Official Secrets Act. - In my personal reflection what matters is that their courage resonates with me through these sentences. A conscientious decision stands. And that's that. Paradoxically, I wonder: Perhaps it helps to be a bit on the introvert and sensitive side... 
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In my neighbourhood nobody clapped for the NHS but I have read about it. I have also read one ex-Brit's facebook post: "I live in (named EU country) where they praise their health system by funding it." Ouch. Like so many, I was attracted from the mid 1970s (when I first visited; finally moved to the UK in 1994), by a sense of a quite unique sense of liberalism - be it expressed by a posh man rolling up his trouser legs in his lunch break and lounging in Hyde Park between Hippies and others while reading (insert name of news paper) or the more formal 'we just have to agree to disagree'. Certainly not an expression easy to translate either. I am not going to moan about how social media and other influences have sharpened the edges of often black-or-white discussions. What I am reflecting on, today, in my personal life as elsewhere is this: We all still have the ability  to keep an open mind - by holding paradoxes. 'And we need it, Both is true'  of course, if taken seriously, is a statement that boggles the mind. Once I have broken through the discomfort of isolation, watching too much telly ... the silence of solitude takes me back to the point where I can hold a paradox: Both is true - some of what comes to mind now: The NHS is fantastic - and crippled through self-obstructing managerialism (not just lack of funding in my view). Brits are unique in their willingness to be charitable and volunteer while also far too willing to vote against their social interests and look away from outdated political (and judicial?) practices. I hope to keep breathing the freedom that can be sensed rather than thought, thinking of some of my previous social work clients who taught me so much about living in the midst of paradox.

https://www.bbc.co.uk/programmes/m000cmzr


BBC Radio 4's consumer program today about the funding for terminaly ill patients. had an informative piece  (about 4 mins into the show) You may also find of interest: fb page of the company 'care to be different'.​