In the case of the incompetent patient, it is suggested that adequate safeguards could take the form of a second medical opinion. It is suggested that the Court's refusal to reach a decision on B's capacity to refuse tube-feeding is prudent. A valid assessment of B's competence would have to take place at the time of her refusal of tube-feeding. The Politics of Hunger Striking. Even if the refusal to eat is tantamount to suicide, as in the case of a hunger strike, he cannot be compelled to eat or forcibly fed.
Patient autonomy is subject to limitations, however.
These two exceptions to the principle of autonomy must be joined by a third - those competent patients who are detained under the Mental Health Act 1983. To refine more accurately the principle stated by Lord Hoffmann, a hunger strike undertaken by a competent patient detained for treatment under the Mental Health Act, where the refusal to eat is a symptom of the patient's mental disorder, constitutes an exception to the general principle that every competent adult has the right to choose whether to eat or not. It is arguable that this may be justified on the grounds that the decision of the mentally disordered hunger striker is motivated by the mental disorder. This is a highly contestable assertion, however. Imposing the medical model upon the events comprising an episode of anorexia is only one of several ways to give meaning to these events.