Eating disorders: Is involuntary treatment ethical?

Eating disorders are often about more than just food. It is a dilemma associated with mental health that involves unhealthy thoughts and behaviors towards food, weight, and body shape. While many people perceive eating disorders as primarily affecting adolescent girls, in reality, they can affect people of any age, race, gender, or sexual orientation. 

Eating disorders can cause significant damage to your health. Malnutrition due to eating disorders can increase the risk of heart and kidney failure. While symptoms for different types of eating disorders vary, they are all significant and harmful to the body. 

Treatment of eating disorders is complicated by numerous ethical factors, perhaps the largest one is the frequent denial of patients to regard the seriousness of their disorder. Recognizing this, most organizations have defined ethical principles to include respect for patients, autonomy, beneficence (the duty to do the most good), nonmaleficence (do no harm), veracity (transparency of the truth), justice, fidelity, and privacy. 

The seriousness of many eating disorders such as Anorexia nervosa are often downplayed, and consequently there is a lack of insight for the necessity and significance of treatment. Thus, treatment refusal, and often, ambivalence due to stigma around eating disorders are among the primary concerns of healthcare professionals treating eating disorders. Issues arise when, after agreeing to treatment, patients begin to refuse important aspects such as adequate meal intake or pharmacotherapy. Such behavior ultimately results in lack of effective treatment and positive results throughout different levels of care. At this point, many healthcare professionals, perhaps pressured due to the patients’ families, may begin to think about treating the patient against their will. While this is not out of the question, particularly for patients where malnutrition has impaired cognitive abilities or there’s a severe lack of insight into the seriousness of the disorder, it is important to recognize that thinking irrationally doesn’t indicate incompetence in consenting to treatment. The decision to treat someone against their will is not to be taken lightly, as it can pose significant side effects such as PTSD from enforced nasogastric tube feedings. 

When determining treatment recommendations and evaluating patient consent, it may be useful to evaluate whether the patient would make the same decision about their treatment if they did not have an eating disorder. This is vital to understanding whether a patient is simply acting irrationally or showing evidence of incompetence. 

However, treatment against will is also warranted and beneficial in some cases — mostly with adolescents. To prevent a chronic course of an eating disorder, early intervention at this age is crucial. Furthermore, many patients have stated after treatment that involuntary hospitalization and enforced treatment have led to a more positive mindset and consent to further treatment. For many, being denied the choice to refuse food can help to alleviate their strong guilt associated with eating. 

With the rise of eating disorders in our society, it is important to educate ourselves on their impact in addition to learning how to evaluate the potential costs and benefits of involuntary treatment in cases of treatment refusal. 

 

~ Saathvika Diviti `25