http://www.dailyrecord.com/story/news/2017/10/24/parents-may-force-feed-anorexic-20-year-old-daughter-judge-ruled/792150001/
"This case was difficult because I was assigned a client who did not want further treatment. I was faced with the ethical dilemma of being assigned a client and having to not follow her wishes. The medical record was clear that she had not reached a position of futility where there was no hope for recovery. Because she is young, had no other medical issues and loving and supportive parents the Court with my support appointed her parents to empower them to help their daughter. For those who follow my sporadic posts last year I advocated for the right of a 29 year old who had so many other health issues secondary to her 20 plus years of Anorexia to discontinue treatment. She died and is at peace. I can only hope my current client opens up to the treatment so there is a better outcome. Thanks all for the support."
MORRISTOWN — Desperate to save their anorexic 20-year-old daughter from death, a Parsippany couple petitioned the court to appoint them her guardians, which would give them power to make medical decisions on her behalf, including force feeding.
Superior Court Judge Paul Armstrong, no stranger to the situation, granted the parents their wish on Tuesday by declaring S.A., as the woman is referred to in court documents, incapacitated and incapable of making her own decisions. The parents were appointed co-guardians of the Parsippany High School graduate.
"This is a case that makes other parents hopeful," said S.A.'s mother following the ruling. The mother, who did not wish to be identified by name, said the petition for guardianship "is a tool for parents to keep our kids alive." The parents asked that S.A.'s identity not be made public.
The ruling comes on the heels of the death of a 30-year-old Morris County woman named Ashley in February. She also suffered from severe anorexia nervosa and refused to eat.
The landmark Karen Ann Quinlan "right to die" case was decided by the N.J. Supreme Court 40 years ago. March 31, 2016 William Westhoven/DailyRecord
Armstrong, who also presided over the Ashley hearing, ruled that she could not be force-fed at Morristown Medical Center, a decision supported by her parents, the hospital's bioethics committee and all her treating physicians. Ashley had undergone a decade of treatment that did not work, according to court documents.
Unlike S.A.'s parents, Ashley's parents wanted their daughter to continue treatment, but wanted to respect her wishes to stop eating and to refuse a feeding tube.
Ashley suffered organ damage and was far more debilitated by malnutrition than S.A. In deciding that S.A.'s parents can make her medical decisions that would include force-feeding, Armstrong cited the Journal of Psychiatric Practice that opines that compulsory feeding in early stages of severe anorexia, before organ failure, can be effective.
S.A.'s physical condition reached a crisis point in June when she weighed 60 pounds and her brother found her after she collapsed in their Parsippany home. She was rushed to Morristown Medical Center, transferred to Overlook Hospital and finally transferred to the Eating Disorders Center at University Medical Center of Princeton, Armstrong said.
Through attorney Susan Joseph, S.A.'s parents in June petitioned the court to be her guardians. S.A. was assigned a court-appointed lawyer, Edward D'Alessandro Jr., who met with her multiple times.
Hearing judge Armstrong made national history in the 1970s when he successfully represented the parents of Karen Ann Quinlan in their court battle to have their daughter removed from life support so she could "die with dignity." Karen, who was in a persistent vegetative state, was removed from life support but lived several more years before her death at Morris View Nursing Home in Morris Township.
In the hearing involving S.A., Armstrong met with her, her treating physicians and mental health workers in Princeton, where she was undergoing treatment including artificial feeding with a PEG tube in her stomach against her wishes. Though she gained about 15 pounds since June in the clinic setting, she told her lawyer and medical staff she can manage her eating disorder on her own and wanted to return to Parsippany, Armstrong said.
S.A. repeatedly told her attorney she was an adult, could make her own decisions and didn't want her parents to act as guardians, Armstrong said.
The medical doctors and S.A.'s psychiatrist said S.A. is delusional and in denial about her risk of dying, the judge said. S.A. has stated, he said: "Being in treatment is torture." She has said she would choose death over treatment, the judge said.
Armstrong said the physicians all opined that S.A. does not understand what the risks to her life are by not eating.
Armstrong concluded S.A.'s parents are loving and want the best for their daughter, even though she has occasionally claimed they were abusive by forcing her to eat at home. Citing medical reports, the judge said S.A. has suffered from anorexia nervosa since she was 13 years old and her body has not gone through puberty because of her condition medically recognized as a psychiatric illness.
The Journal of Psychiatric Practice, in a treatise titled "Caring for Patients with Severe and Enduring Eating Disorders," states anorexia nervosa has a high mortality rate.
"The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment. Involuntary treatment may therefore be both life-saving and critical to recovery," the article states.
The judge noted S.A., though seriously ill, still has a chance of recovery through the guardianship of her parents who will see that she receives continued treatment at the Princeton facility and then at a long-term residential facility.
