Anorexic Morris County woman who resisted force-feeding has died

MORRISTOWN - A 30-year-old Morris County woman, who was anorexic and bulimic since adolescence, has died at Morristown Medical Center, three months after a Superior Court judge ruled that she could not be artificially fed against her wishes.

"I feel glad that she is no longer suffering but I feel a profound sense of sadness that modern science and all the efforts by a strong, loving family couldn't overcome this problem," said Edward G. D'Alessandro Jr., the court-appointed attorney for Ashley G.

Ashley, who grew up in Morris County and unsuccessfully tried individual and family counseling and an array of in-patient eating disorder clinics, died Monday around noon in the hospital's palliative care unit, D'Alessandro said.  Neither Ashley's parents, nor her court-appointed guardian Susan Joseph, could immediately be reached by the Daily Record.

Ashley was the focus of a ruling on Nov. 21 by Superior Court Judge Paul Armstrong in Morristown, who as an attorney had represented the parents of Karen Ann Quinlan in the 1970's when Joseph and Julia Quinlan fought successfully to have their daughter - who was in a persistent vegetative state - removed from a ventilator so she could die with dignity.

Ashley, who also suffered alcoholism and depression, had been involuntarily committed to Greystone Park Psychiatric Hospital in 2014. When Ashley's weight reached about 60 pounds in June 2016, she was hospitalized at Morristown Medical Center. Susan Joseph was named Ashley's guardian and Joseph petitioned Superior Court to initially have Ashley force-fed, which caused the young woman to gain about 30 pounds but led to "re-feeding syndrome," which damaged her heart.

Joseph later petitioned the court to honor Ashley's wishes to cease all artificial force-feeding. D'Alessandro agreed with the decision. Deputy attorneys general representing the Department of Human Services, however, wanted a judge to order force-feeding through a nasogastric tube even while recognizing that Ashley would have to be held down for the tube insertion and could suffer bone breakage.

The deputy attorneys general had argued that Ashley was not competent to make the decision to refuse food. In his opinion, Armstrong cited multiple landmark court rulings, including the Quinlan decision, that recognize an individual's right to refuse treatment and that in the absence of competency, others can make the decision to refuse treatment or food on behalf of the incompetent person.

Armstrong had visited Ashley at the hospital in early November 2016 and determined that she was clear in her wishes to refuse food and reject artificial feeding measures. Armstrong also heard lengthy testimony from an eating disorder specialist for the state who believed Ashley possibly could be helped through a regimen of increased time with family, force-feeding and experimental doses of Ketamine for her depression.

Many specialists, including a hospital physician, Ashley's treating psychiatrist, her parents and the hospital's Bioethics Committee sided with Ashley's wishes. Her mother had told the court that Ashley wanted peace after trying for years to overcome her eating disorders but that she would jump to help her daughter if she ever wanted to try again.

Armstrong determined that the people closest to Ashley and familiar with her life and struggles were best suited to give voice to Ashley's wishes. Though he had found that Ashley seemed to understand the consequences of refusing to eat, the judge's decision was supported by the specialists and relatives of the alleged incompetent Ashley.

"In a paradigm of this proper cooperative spirit, there now appears before this court the patient A.G., her mother and father, her treating psychiatrist and internist, the members of the Morristown Medical Center Bioethics Committee, her legal guardian and her legal counsel, who in one compassionate, solicitous and uniform voice urge this court to authorize the transfer of the patient A.G. to the palliative care unit of Morristown Medical Center in order that she may be treated with a comfort care plan designed to address her dire diagnosis and poor prognosis," Armstrong said in his ruling.

The judge quoted from another state Supreme Court case, that of Hilda Peter who was removed from a respirator: "Whether grounded in common law or constitutional law, our courts have uniformly recognized a patient's right to refuse medical treatment as a fundamental tenet of respect for patient autonomy, dignity and self-determination and have consistently held that the incompetent patient's right may be exercised by an appropriate surrogate on the patient's behalf."

The state Department of Human Services did not appeal the judge's decision.

 Staff Writer Peggy Wright: 973-267-1142; Pwright@GannettNJ.com.