You are the Chief Executive of a Local Health Network is New South Wales. E is a patient in one of your hospitals. E had suffered from anorexia since her early teens, brought about by serious sexual abuse which she experienced between the ages of 4 and 11. Despite the challenges of her illness, she was universally described as intelligent and articulate and had completed several years of a medical degree at university before her illness rendered it impossible to continue. She had undergone a number of admissions for medical and psychiatric care, including legislative sectioning on about 10 occasions. In July 2012 E signed a document saying that she did not want to be resuscitated or to be given any medical intervention to prolong her life.
In October 2012, she signed another advance directive in a standard form, assisted by her mother. Following her discharge and return to the community, a familiar pattern re-asserted itself. By early 2013 E was drinking very heavily. She was re-detained in March 2013 and was initially fed by tube but opposed this and tube feeding was stopped. As a result, she has not been taking any calories at all since the end of March. On 20 April 2013 E was admitted to a community hospital for palliative care and placed on an ‘end of life’ care pathway with high doses of opiate medication, to which she is physically addicted.
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