A Morris County, New Jersey woman who suffers from severe anorexia and weighs a mere 69 pounds may not be force-fed, as ruled by a superior court judge on Monday, November 21. The 29-year-old has been a psychiatric patient at the state’s Greystone Park facility since 2014 upon having been found unconscious in a hotel room after drinking alcohol and overdosing on an antipsychotic drug. In early November, the young woman expressed her desire to enter palliative care, stating she refused to eat any food and would continue to do so, despite understanding the willful deprivation of her body’s necessary nourishment would likely lead to her death, which she says she is prepared for. Morris County superior court judge Paul Armstrong granted her wish and has ordered she be transferred to a palliative care unit.
Palliative care is otherwise reserved for terminally ill patients for the purpose of keeping them comfortable and pain-free during their transition toward inevitable death. The young woman, her family, her physicians and psychiatrist collectively believe this to be the best option for her, as she has suffered from anorexia for most of her life and all other intervention efforts have proven unsuccessful in curing her of the devastating disease. At 5’6″, the woman, whose name has been withheld and is referred to in the case as A.G., has a bone density of a 92-year-old.
The landmark decision to allow her to starve herself to death is a complicated one, as it deals with her personal privacy rights to dictate whether or not she eats versus the legality surrounding the state’s knowledge of her slow suicide, which is their primary concern. Because the facility where A.G. currently resides is state-run, they believe she is not of sound mind and body to make such a decision for her herself, stating in addition to anorexia, she also suffers from severe depression, alcoholism and mental illness. However, Dr. Joshua Braun, who is her attending psychiatrist, stated he believed force-feeding her would be “cruel and tortuous at this point,” because she would have to be physically restrained to insert the tube, sometimes up to three times a day. He said because her bones are so fragile and the process of tube-feeding so invasive, she would likely suffer more than less due to broken bones and other issues.
Force-feeding involves the insertion of a small tube through the nose and down the throat; for someone who is opposed to the procedure, they are likely to resist and fight against it, leaving them vulnerable to greater injury during the process. A.G. has made it clear she believes weighing over 70 pounds would make her fat and she wants no part of it.
As for her mental acuity, judge Armstrong verbally stated in his judgment, which lasted 140-minutes, he believed her testimony regarding her condition and desire to enter palliative care was “forthright, responsive, knowing, intelligent, voluntary, steadfast and credible.” As such, he ruled in her favor believing she is aware of her decision to refuse sustenance, along with the probable consequences of her choice. The judge also noted that because her condition has progressed to its current dire and grave state, requiring her to be force-fed might actually be more dangerous than letting her starve.
A.G. had previously been force-fed at the facility (though she eventually removed the feeding tube herself), which resulted in a 30 pound weight gain, bringing her frail frame up to 90 pounds. Unfortunately, it also resulted in heart failure due to what is known as “re-feeding syndrome.” The re-introduction of food into an intensely vulnerable and severely malnourished body can shock its system, thereby causing further, sometimes mortal harm.
Aware of the controversy surrounding his ruling, judge Armstrong cited the 1976 case of then 22-year-old Karen Ann Quinlan, whose family he represented, wherein the Supreme Court ruled she could be removed from the ventilator that was keeping her alive while in a permanently vegetative state; her family believed she had the right to die without being kept alive by machines knowing she would never regain the quality of life she once had. He also noted A.G.’s parents have been actively involved in seeking help for their deeply troubled daughter, having attended therapy sessions with her, admitting her to countless eating disorder programs and essentially structuring their entire lives around their daughter’s illness to no avail.
As Armstrong said, “The lessons of the landmark cases of Karen Ann Quinlan, Clare Conroy, Nancy Ellen Jobes, Kathleen Farrell, Hilda Peter, and Nancy Cruzan are that patients, their families, physicians, and their institutions remain proper cooperators in making the evolving and necessary difficult decisions fronting modern medicine.”
Eating disorders are too often overlooked as the serious, life-threatening diseases that they are, especially in our overly saturated society of what “perfect” looks like. Anorexia is about control; a person may not be able to control the chaos happening around them, but they can control what they put in their mouth, which can lead to a dizzying downward spiral that in an ironic and tragic twist, becomes the most uncontrollable beast, taking everyone who comes near it down with it.
One can only hope this ruling brings the peace to A.G. and her family they so desperately need and unquestionably deserve.