Citation

Dyer C. Br. Med. J. BMJ 2000; 320(7237): e731.

Copyright

(Copyright © 2000, BMJ Publishing Group)

DOI

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PMID

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Abstract

Ian Brady, who has been in prison for over 30 years for murdering three children, last week lost his fight to stop doctors force feeding him through a nasogastric tube, when a High Court judge ruled that their decision to do so was "lawful, rational, and fair." Brady, who is detained in Ashworth special hospital near Liverpool, was probably "playing the system" in undertaking his hunger strike, said Mr Justice Kay at the High Court in Liverpool. The judge accepted the view of James Collins, consultant forensic psychiatrist at the hospital, that Brady's refusal to eat was "a florid example of hispsychopathology in action." Dr Collins described Brady as psychopathic and prone to narcissism, egocentricity, histrionics, obsessionality, need for control, paranoia, litigiousness, lack of remorse, and lack of empathy. In the past he had referred to receiving a "massive psychological boost" from earlier hunger strikes, which he saw as "a battle of wills." Brady started his hunger strike last October after he was moved without warning from one ward in Ashworth to another, by a six man control and restraint team in balaclava helmets and full riot gear. His right arm was fractured in the move. Under English law, a patient who is competent to take decisions may not be treated--including by artificial feeding--against his or her will. The exception is patients covered by the Mental Health Act 1983, who may be treated against their will even if they are competent--but only if the treatment is for their mental disorder. The judge held that the force feeding was treatment for Brady's mental disorder. But even if the act had not applied, he was satisfied that Brady was incompetent, and therefore doctors could lawfully feed him in his best interests. As a result of his severe personality disorder, said the judge, Brady had eschewed the weighing up of information and the balancing of risks and needs. So doctors were legally empowered to supply medical treatment in his best interests. Brady, aged 62, who attended the hearing but did not give evidence, was making his first court appearance since 1966, when he was convicted of the murder of three children, two of them with his accomplice, Myra Hindley. The judge said that he was not satisfied that Brady had at any time expressed a clear wish to die. He made no ruling on a hospital authority's duty or power to prevent suicide. The judge refused Brady leave to appeal. © 2000 BMJ Publishing Group Ltd.

Language: en

Keywords

article; Enteral Nutrition; enteric feeding; Great Britain; human; Humans; law; Legislation; prisoner; Prisoners; United Kingdom