Re ERe E

‘‘I don’t want to eat, but I don’t I don’t want to eat, but I don’t want to die’want to die’

32 yo female32 yo female 1818thth May 2012 COP application May 2012 COP application Severe ANSevere AN Refusing to eatRefusing to eat On Palliative care regimeOn Palliative care regime

BackgroundBackground 2 sisters2 sisters Happy early childhoodHappy early childhood Sexually abused between ages of 4-11Sexually abused between ages of 4-11 Age 11 started to control eatingAge 11 started to control eating Age 12 binge eating, SIV, and ETOHAge 12 binge eating, SIV, and ETOH Age 15 admitted EDU for 9/12Age 15 admitted EDU for 9/12 Successful schooling and started studying Successful schooling and started studying

medicinemedicine Relationship led to travelling, ETOH and Relationship led to travelling, ETOH and

dropping out. Remembered as happydropping out. Remembered as happy

2006 onwards continuous series of 2006 onwards continuous series of emergencies and admemergencies and adm

3 specialist EDU (3,5 then 8 months)3 specialist EDU (3,5 then 8 months) 1 ETOH treatment unit (2/12)1 ETOH treatment unit (2/12) ‘‘Revolving door’Revolving door’ MHA 10 occ. Longest 4/12MHA 10 occ. Longest 4/12 Relationship ended in 2008Relationship ended in 2008

Advanced decisionsAdvanced decisions

July 11 no medical intervention to prolong July 11 no medical intervention to prolong lifelife

Oct 11 signed another and detained that Oct 11 signed another and detained that dayday

33rdrd April 2012 unanimous decision that all April 2012 unanimous decision that all treatment options exhaustedtreatment options exhausted

2020thth April palliative care pathway April palliative care pathway

DxDx

Severe ANSevere AN BPDBPD ADSADS Opiate dependenceOpiate dependence MalnutritionMalnutrition OsteoporosisOsteoporosis Hip replacementHip replacement Wheel chair boundWheel chair bound

BMIBMI

<14 for 4 years<14 for 4 years <12 for 2 years<12 for 2 years Current 11.3Current 11.3

OptionsOptions

No interventionNo intervention Prolonged IP adm with forced feedingProlonged IP adm with forced feeding