Feb 25 2011

grace01pd2012

The Right to Refuse Treatment for Eating Disorders

Skewed PerceptionFor countless years, eating disorders have been a major issue, more commonly among girls than boys. Although multiple types of therapy and steps towards recovery have become available, a new question has surfaced: do people suffering from eating disorders, specifically anorexia nervosa, have the right to refuse treatment? One side (source A) considers the fact that anorexia nervosa patients endanger their lives and at some point, could become incapable of making sound decisions about their wellbeing. On the other hand (source B), it is debated that some patients possess enough competence to understand their condition and make a reasonable decision about their health.

When considering anorexia nervosa, it is important to acknowledge that “eating disorders are psychiatric, not biological, illnesses” (source A). This statement can be furthered to express that “self-starvation can interfere with conceptualization, perceptions, and decision making” (source A), ultimately affecting a patient’s ability to assess his or her own situation. Because “the disorder itself impairs judgment” (source A), psychologist James L. Werth Jr. argues that patients are not capable of deciding whether or not they need therapy, and they are considered to be “legally incompetent” (source A). It is shown that anorexia patients are not in the correct mental state to make such decisions, and therefore others should be able to intervene in times when the patient’s life is at risk. There is “a duty to protect” (source A).

In response to the idea that people suffering from anorexia are mentally inept, bioethicist Simona Giordano asserts that “competent anorexics have the same ethical and legal right to refuse medical treatment that terminally ill people have” (source B). If people are able to understand treatment and its purpose, including risks and benefits, then they are capable of making the decision about therapy (source B). There are times in which death is inevitable or patients are deemed chronically ill, and in these cases, supporters of voluntary treatment believe that others must accept a patient’s decision. A primary source (from source B) states, “Everybody should have the right to choose whether they want to live or die, it’s not fair that they should take away the choice from them.” In this case, there is no duty to protect, merely a duty to respect and obey.

Looking on the discussion from the outside, the eating disorder debate appears quite objective and straightforward; how does it affect me if some teenager literally starves herself to death? It doesn’t. The realization that people on the outside must make is that just because a girl has this desire for emaciation and eventual death, it does not mean we must stand by helplessly without interference. “Unlike those with other conditions, clients with anorexia value and seek the symptoms of their disorder (i.e., thinness and starvation)” (source A). If an individual approached a group with a suicide plan involving a gun, or a knife perhaps, we wouldn’t stand by in that case, would we? Most people would get involved. Anorexia is the same way. Sufferers near the point of death or severe self-harm are in no condition to make decisions about their health, and involuntary treatment is, in the end, justified.

Source A: James L. Werth Jr. et al., “When Does the ‘Duty to Protect’ Apply with a Client Who Has Anorexia Nervose?” Counseling Psychologist, vol. 31, no. 4, July 2003.

Source B: Simona Giordano, “Anorexia Nervosa and Refusal of Naso-Gastric Treatment,” Bioethics, vol. 17, no. 3, June 2003.

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