By Sydney White, 18th November 2025
The protected party at the centre of this case, LV, is a 20-year-old woman diagnosed with anorexia nervosa, autism spectrum disorder, severe depression, and anxiety. At the time of the first Court of Protection hearing, in early 2025, she was an inpatient on a ward in a specialist eating disorder unit (SEDU) of a university teaching hospital where she’d been for more than 2 years (and for a year before that on different hospital wards). She was detained under section 3 of the Mental Health Act 1983.
In February 2025, LV was very unwell. The Hospital Trust and the NHS Mental Health Trust responsible for her care made an urgent application to the Court of Protection. The case (COP 20011799) was heard in the Royal Courts of Justice by Mrs Justice Morgan. The published judgment reports:
“She is presently being fed twice a day using a Naso Gastric Tube. She has to be restrained for this. The process requires seven staff members. Since December of last year, this process has been largely ineffective in providing her with nutrition since she has developed the ability, at will, to regurgitate feed whilst it is being delivered and to purge by vomiting most, nearly all, of the remainder after delivery. In that time she has lost a further 15% of her body weight. Her body mass index is slightly over 11. The likelihood is that, absent effective intervention, she will die soon. It is difficult to predict when that may be, but the evidence before me is that a timescale of days or weeks is what is contemplated rather than one of months.” (St George’s University Hospitals Foundation Trust & Anor v LV [2025] EWCOP 9 (T3)).
The Trusts were applying for (i) a declaration that LV lacks capacity to conduct proceedings and to make decisions about her care and treatment and (ii) a declaration that it is lawful and in LV’s best interests to be admitted to an Intensive Care Unit for a period of feeding under sedation. This was seen as a “last resort” option – the consensus view being that if she stayed where she was, death would be likely in days or weeks, and that feeding under restraint was not in her best interests either as it would be very high risk because she pulls out tubes and lines.
Here’s how the option of feeding under sedation was described in the written evidence before the court:
Go to General Hospital and be admitted to ITU for feeding while intubated under general anaesthesia: She will be under general anaesthesia and fed while asleep. The list of medical risks are as listed below, derived from the best interests meeting from the ITU intensivists, gastroenterologist, and medical nutritionists at St George’s Hospital. The process would involve being put to sleep, then doctors inserting a breathing tube and then using a ventilator machine to take over breathing. She would then be kept asleep using medication and fed while asleep. The first concern is that while she is asleep, she will continue to lose muscle mass while sedated – this may be up to 10% a week. Explained this carries risk of critical illness myopathy, which would leave her profoundly weak, potentially unable to move her limbs, and this could be irreversible. Another risk was requiring a tracheostomy (a breathing tube in the neck), and that there is a chance she would require this in the longer term – this would leave her requiring a permanent placement in a facility able to accommodate this, which may be a neurodisability hospital. Another risk was that she would be at very high risk of infection, both a chest infection related to being on a ventilator, or from a line. This would carry risk of multi-organ failure and death. In the first week, there would be risk from being put to sleep, and also from her heart reacting to us starting to feed her. (§8 of the judgment).
The judge said it was “sobering against the backdrop of that level of risk, to reflect on the fact that the unanimous view of all of those treating and caring for LV is that it should be taken and is in her best interests to do so”. And that was the decision she made.
“I have thought long and hard about all of those risks and detriments as I weigh the balance. The point about the balance however is to look at what it is that falls on the other side. Here when I look at the other side, at what lies in the balance against all that is risky; all that which in other circumstances would be an intolerable affront to her autonomy, what I contemplate is her imminent death. At the moment twice a day, LV is subject to what, in other times and contexts, was called ‘force-feeding’. The means by which it is achieved, for all the empathetic approach and skill of the staff, is not so very far removed from the images which that phrase conjures up. Yet for all the pain distress and indignity of it (during all of which she is emotionally and physically present) it is achieving nothing. LV is starving to death.”(§57, judgment)
And so, the judge concluded: “I am satisfied that it is, in all the circumstances of this most unusual and troubling case, in LV’s best interests to undergo the proposed course of treatment” (§58).
Hearings observed
I observed two subsequent hearings in this case, both remotely and both before Morgan J: the first on 7th April 2025 and the second on 18th June 2025. There have been no further published judgments, so this report is an “update” on what happened with LV after the (only) published judgment in this case, and after the refeeding in the ICU that it authorised. As far as I know, there have been no further hearings since June 2025.
April hearing
LV had been woken up after nearly 7 weeks in the ICU. She had gained weight more quickly than expected and now had a BMI of 13.5.
The views of LV herself had not been canvassed by the Official Solicitor, or by the court, either at the February hearing, or at this one. The Official Solicitor, represented by Fiona Paterson KC had not been able to speak with LV earlier in the year before she went into the ICU due to how ill she was. She said now: “In terms of P being involved in her own case, I have invited her to speak with me over a video link. We’ve been guided by her parents because though happily LV came off the ventilator in the second week of March, she’s been receiving varying levels of sedation, and we don’t want to impose upon her until she feels ready, but have made it clear that we are happy to go on a link and wave at her and say no more, if only to impress upon her that she has her own representation.”[i]
The judge, who expressed repeated concerns (in the published judgment as well as at this hearing) that LV should not be treated as a child, and that her (albeit non-capacitous) views about treatment should be properly elicited, said in reply: “There is no reference to LV’s views being expressed in any reports from various clinicians, so I am much reassured by what you’ve told me”. She also wanted “disclosure of documents and reports about the involvement of this adult patient herself” in treatment decisions going forward. As Fiona Paterson said, however, “to keep calm and tolerate being fed, she’s needed varying levels of sedation and not been well enough to have a chat with someone new. We don’t want to get off on a bad start”.
It was agreed by the Official Solicitor and the applicant NHS Trusts (represented by Vikram Sachdeva KC) that LV should be moved to a Specialist Eating Disorder Unit (SEDU). LV, herself, had expressed a wish to move there. But this was complicated by several factors. First, only one SEDU was put forward as potentially being able to accept LV as a patient. Second, LV required two adjacent rooms, not one, to accommodate her needs. Third, LV’s acceptance to the SEDU was conditional upon improvements in her disordered eating and funding by an NHS Trust provider collaborative. Nevertheless, it was anticipated that LV would be in the SEDU by the end of May.
June hearing
At the time of the hearing on 18th June 2025, LV was still on the hospital ward, and her health was deteriorating both physically and mentally. She was ‘purging’ more frequently and her BMI was dropping. On discharge from ICU in early April, her BMI had been 13.5. By 1st May 2025 it had dropped to 12.2 (representing a loss of 3.4kg since her discharge from ICU). By 16th June, the Trusts (now represented by Victoria Butler-Cole KC) reported that LV’s BMI was 11.7 – very close to where it had been a few months earlier before admission to the ICU.
Things were not going well. The SEDU had not yet committed to giving LV a bed, and the provider collaborative had not yet agreed to fund whatever place the SEDU may offer. Morgan J labelled this, in no uncertain terms, ‘a dismal state of affairs’.
The new counsel for the applicant NHS Trusts, questioned whether the Court of Protection had any further jurisdiction in regard to LV’s care. Morgan J disagreed, emphasising the ‘unattractive’ consequences of ‘drift and delay’ and her unwillingness to “leave this young adult in circumstances where a decision could be made without the best information that can be obtained’“. The judge issued an order directing that the NHS Trust provider collaborative file a statement by 2nd July identifying:
- Whether the SEDU had confirmed it would offer LV a place
- What the conditions of the offer were, in terms of LV’s physical health and behaviour
- The proposed dates of admission, or a fixed date by which that date would be known
- Whether the provider collaborative had agreed to fund LV’s placement at the SEDU
- If the provider collaborative has not agreed to commission the placement, an explanation for why it had reached that decision
- If the SEDU had not made an offer, what the provider collaborative proposed to commission for LV instead.
This is clearly an attempt to bring some certainty and focus to the “chicken and egg” situation, as Morgan J called it, in which LV had found herself: the offer from a SEDU being conditional upon a change in LV’s behaviour, but a change in LV’s behaviour being very difficult to achieve without access to a SEDU. It is Morgan J’s attempt to exert enough pressure on the various parties involved in LV’s care so that LV might leave the hospital ward, where her health was likely to continue deteriorating. Indeed, it effectively encapsulates Morgan J’s repeatedly-expressed dismay and disappointment at “the ever-moving and uncertain responses to the core question that LV is asking, which is: ‘when can I go there”‘”.
The order states that if a place at the SEDU were to be confirmed and a fixed date for LV’s transfer identified, then in that case the hearing—scheduled for 11th July 2025 —would be vacated.
No hearing was publicly listed for this case for 11th July 2025. I hope that LV did, at last, find certainty and solace in a place at the SEDU.
Sydney White recently completed her MPhil (Master of Philosophy) in Medical Law at the University of Oxford, having also graduated from Oxford’s undergraduate law program. Her thesis focussed on the Court of Protection’s approach to best interests assessments for patients with anorexia nervosa under the Mental Capacity Act 2005. Her fascination with Medical Law brought her to the Open Justice Court of Protection Project. She has previously published these blog posts: An in-person hearing on anorexia (Re CC): Observer’s rollercoaster and the role of “hope”; Respecting autonomy in treating Anorexia Nervosa, and Cross-jurisdictional challenges and Schedule 3 in a case of anorexia: Health Service Executive of Ireland v SM [2024] EWCOP 60. She can be found on LinkedIn at www.linkedin.com/in/sydney-e-white, on Twitter/X @sydwhiteCOP and on Bluesky@sydneywhite
[i] From notes made contemporaneously during the hearing, which (since we’re not allowed to audio-record hearings) are unlikely to be 100% verbatim, but are as accurate as I could make them, with the help Celia Kitzinger who shared her notes with me.
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