1. Re E I dont want to eat, but I dont want to die

2. 32 yo female 32 yo female 18 th May 2012 COP application 18 th May 2012 COP application Severe AN Severe AN Refusing to eat Refusing to eat On Palliative care regime On Palliative care regime

3. Background 2 sisters 2 sisters Happy early childhood Happy early childhood Sexually abused between ages of 4-11 Sexually abused between ages of 4-11 Age 11 started to control eating Age 11 started to control eating Age 12 binge eating, SIV, and ETOH Age 12 binge eating, SIV, and ETOH Age 15 admitted EDU for 9/12 Age 15 admitted EDU for 9/12 Successful schooling and started studying medicine Successful schooling and started studying medicine Relationship led to travelling, ETOH and dropping out. Remembered as happy Relationship led to travelling, ETOH and dropping out. Remembered as happy

4. 2006 onwards continuous series of emergencies 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 4/12 MHA 10 occ. Longest 4/12 Relationship ended in 2008 Relationship ended in 2008

5. Advanced decisions July 11 no medical intervention to prolong life July 11 no medical intervention to prolong life Oct 11 signed another and detained that day Oct 11 signed another and detained that day

6. 3 rd April 2012 unanimous decision that all treatment options exhausted 3 rd April 2012 unanimous decision that all treatment options exhausted 20 th April palliative care pathway 20 th April palliative care pathway

7. Dx Severe AN Severe AN BPD BPD ADS ADS Opiate dependence Opiate dependence Malnutrition Malnutrition Osteoporosis Osteoporosis Hip replacement Hip replacement Wheel chair bound Wheel chair bound

8. BMI <14 for 4 years <14 for 4 years <12 for 2 years <12 for 2 years Current 11.3 Current 11.3

9. Options No intervention No intervention Prolonged IP adm with forced feeding Prolonged IP adm with forced feeding