|Oftentimes in medicine, patients refuse care that a care staff has deemed necessary to save their lives. When a patient’s health is clearly salvageable, involuntary hospitalization becomes a crucial treatment option. In the context of mental illnesses like anorexia nervosa, this care method is questioned since disregarding a patient’s explicit will seems to conflict with her autonomy. However, for anorexia, there is another factor to consider: the extent to which the disease acts as a coercive factor in shaping her decisions regarding health and body. Despite understanding the nature of the illness, a patient with severe anorexia often fails to comprehend the depth to which the disorder infiltrates her life. Considering this impediment on her specific medical judgment, it does not seem right to grant such a patient the ability to reject medically-necessitated, life-saving care. Thus compulsory care seems to not only be the kindest option but also ethically mandated.|
In the field of medicine, patients do not always accept professional advice about the best course of treatment. A clinician’s obligation to protect the patient’s health creates tension with the patient’s fundamental right to refuse care. For severe mental illnesses such as anorexia nervosa, doubts about decision-making capacity stemming from the patient’s unstable psychological state complicate the issue of compulsory detainment as a life-saving measure. According to Mental Health America (MHA), hospitalization of mentally ill patients is only acceptable when the person poses an imminent threat to herself or someone else. In the case of anorexia, we articulate this threat by asking: To what degree is the disease itself coercive, controlling one’s thoughts, attitudes and emotions? The ethical dilemma in this context must consider the specific tolls that the disorder takes on patient decision-making capacity as well as the varying effectiveness of relevant healthcare techniques. The question becomes: does the nature of the illness provide legitimate reason to disregard the patient’s apparent wishes?
The issue of coerced treatment is relevant to a range of parties who must assess important practical and ethical issues. Notably, medical decisions in the US are not only the product of patient and physician inclinations but also insurance coverage and state legislation. Because hospitals must be conscientious of financial costs, a patient’s economic resources may be crucial to their path of medical treatment. For example, a study by Fisher et al. found that a committed person’s length of stay often depended heavily upon insurance status, and without insurance, patients would be released sooner (Fisher et al., 2001, pg. 344). Additionally, many state laws provide guidelines for civil commitment. The legal standard for detaining a person with a mental disorder depends on the threat she poses to herself; she must be “suicidal, physically violent, or grossly unable to perform activities of daily living” (Testa and West, 2010, pg. 34). Since detainment of patients with mental illnesses is frequently accepted in cases where the disorder skews interpretation of reality, the question is more ambiguous when this perception is not compromised, as in eating disorders, drug addiction and personality disorders, for instance (Testa and West, 2010, pg. 31). However, clinicians do not always agree on whether these standards have been met in eating disorder patients, and the American Psychiatric Association lacks a specific protocol to direct involuntary hospitalizations of these persons (Testa and West, 2010, pg. 37).
We will address a general case of severe anorexia with certain guidelines to ensure that we are assessing the core of the issue: whether involuntary care truly puts into conflict a patient’s right to refuse care and a clinician’s duty to act in the patient’s best interests. Our example involves a woman between ages 18 and 25 since “95% of those who have eating disorders are between the ages of 12 and 25.8” (“Eating Disorders Statistics”). Otherwise physically healthy, the patient has life-threatening anorexia and refuses treatment that her therapist and/or physician strongly believes will restore her physical condition. We focus on an adult patient rather than a minor to ensure that doubts about her decision-making faculties do not stem from her youth, inexperience or incomplete brain development. Rather, the question about her capacity to give consent arises from mental health considerations – namely, distorted values engrained in her by the eating disorder. Finally, and most essential to this debate, her clinician contends that the severity of her condition demands urgent care. Otherwise, compulsory treatment may not seem like a rational option if the proposed treatment is not of immediate value to the patient’s health. She seems to understand this, yet she rejects aid.
One solution to this case balances protecting the autonomy of the patient and caring for her physical health by the beneficence principle. “Beneficence” here means acting with the goal of creating what the caregiver believes is the best outcome for the patient. This investigation is part of the broader issue of whether compulsory treatment is ever justifiable – a discussion that requires consideration of the nature of the illness and potential effectiveness of care. If thorough clinical evaluation determines that the patient’s condition can improve, I argue that involuntary treatment of anorexia under the given conditions is not only justifiable but morally imperative because (1) the patient’s disorder interferes with specific decision-making capacity regarding health and body, undermining her autonomy, and (2) denying her treatment is not in her best interests if allowing her to live with an untreated life-threatening disease will likely lead to her death.
“Treatment” refers not only to hospital detention but also replenishing the patient’s physical state. These two elements of care have significantly different moral implications; namely, the former may be restricted by time (e.g. 72 hours), whereas the latter is determined by rate of recovery (e.g. a specific body mass index (BMI)). The US handles involuntary detainment of mentally ill patients by individual state laws (“Emergency Hospitalization”). Many states demand immediate medical evaluation of a patient who is in danger as a result of his or her disorder (Testa and West, 2010, pg. 34). In such cases, hospitalization is considered justifiable and obligatory so long as an authority (say, a physician, clinician or police officer) deems the patient’s condition life-threatening (“Emergency Hospitalization”). With respect to medical care, Position 22 of MHA contends that “involuntary treatment should only occur as a last resort and should be limited to instances where persons pose a serious risk of physical harm to themselves or others in the near future and to circumstances when no less restrictive alternative will respond adequately to the risk.” Although mental illness treatment insurance boosted enormously after the 2013 Affordable Care Act (“After Parity”), the US does not have a federal policy to protect the health of noncompliant patients with severe mental illnesses. However, other countries have explicit laws to address involuntary hospitalization, specific to the disorder. For example, the Mental Health Act Commission in England requires
“that in certain situations, patients with severe anorexia nervosa whose health is seriously threatened by food refusal may be subject to detention in hospital and further that there are occasions when it is necessary to treat the self-imposed starvation to ensure the proper care of the patient” (qtd. in Ramsay, 1999, pg. 147).
In the US, state commitment laws for mentally ill patients recognize the attenuating impact of psychological disorders on a person’s health, yet these policies only provide a route for compulsory treatment rather than a duty, and the extent to which eating disorders apply is not obvious.
Beyond hospitalization we must also consider whether it is just to invoke involuntary treatment methods for patients with life-threatening anorexia. Such techniques often involve coerced regular meals, nutritional supplements, ingestion of calories via nasogastric tube, parenteral nutrition, and even isolation or physical restraint to ensure consumption of food (Matusek and Wright, 2010, pg. 435). These forms of care are morally ambiguous because attempts to secure the patient’s health in the long-term may involve a more significant restriction on her autonomy than simply requiring a 72-hour stay for the purpose of examination preceding release. In order to respect the often persistent nature of the illness, consideration of the patient’s best medical interests includes action that promotes more permanent treatment outcomes. Rather than focusing on the ethical implications of each individual care method, we examine the idea of compulsory hospitalization with the understanding that a medical care staff will invoke necessary and compassionate measures to safely return the patient to a physically and mentally stable state.
The patient’s explicit wishes may be contrary to the values she prioritized before her disorder progressed. Therefore, adhering to her expressions of treatment rejection seems to give in to the eating disorder’s potency. If the patient’s illness acts as a coercive force in her decision to refuse, the choice is not truly self-driven, so contradicting her outright wishes may actually defend her autonomous faculties as we understand them in a healthy mental state.
Protecting Patient Autonomy
The strongest objection to involuntary hospitalization appeals to the idea that contradicting a patient’s volition is morally unacceptable. Often considered a human right, autonomy defends a person’s life-shaping freedom, command over body, and self-determination. The legal concept of informed consent defends this right with exceptions for minors and, sometimes, mentally ill persons whose disorders undermine their judgment with respect to their health. In the case of compulsory treatment of anorexia, issues to consider regarding the patient’s autonomy include (A) how consequences of the illness limit her decision-making capacity and (B) whether it is justifiable to disrespect present autonomy for the sake of restoring her autonomy in the future. If compulsory treatment does not actually violate the principle of autonomy, involuntary care may be morally necessary given the severity of her illness.
Regarding (A), if physical and psychological effects of anorexia diminish the patient’s decision-making capacity in the domain of her health, compulsory treatment may be justifiable. Restricting her autonomy in the short-term does not limit her freedom on the whole when disorder-related consequences and beliefs act as coercive forces at the time of admission. The Supreme Court case SW Hertfordshire Health Authority vs. KB (1994) upheld this position, permitting force-feeding as a means of care since the anorexia of patient KB undermined her decision-making capacity (Dolan, 1998, pg. 171). However, a powerful argument against such logic contends that consent is always necessary for adult patients unless they are unconscious (Rathner, 1998, pg. 193). Being “conscious” here assumes awareness and capacity to process information. But what about the ability to weigh relevant options rationally in order to make an informed decision? Decreased physical functioning resulting from starvation may damage this capacity. A patient’s refusal of treatment may be influenced by biochemical changes in her brain stemming from nutritional deprivation – a notable limit on her cognitive functioning (Vitousek et al., qtd. in Matusek and Wright, 2010, pg. 442). A study published in The Biology of Human Starvation by the University of Minnesota Press reported that participants who were “semi-starved” in the experiment had decreased focus, understanding and decision-making ability as well as overwhelming emotions and even depression (Kaplan and Rucklidge, 2013). Likewise, in a study by O.A. Tan, numerous women with anorexia were found to relate experiences of “difficulties with concentration and muddled thinking processes” (Tan et al., 2006). Considering the extreme cognitive consequences of insufficient calorie consumption, we should be hesitant to deem a patient with severe anorexia capable of rationally refusing treatment of her eating disorder.
An alternate view contends that even if anorexia undermines decision-making capacity by virtue of the physical symptoms of the disorder, how is this different from a patient with life-threatening yet treatable cancer who must give informed consent for chemotherapy? After all, such a patients may also have decreased mental functioning at the time of consent as a result of physical weakness and fatigue, for instance. Why should we deny a person with anorexia the right to refuse care when we consider a non-anorexic patient with notably similar physical symptoms capable in this respect?
This objection is problematic because it fails to acknowledge psychological factors directly associated with many mental illnesses like anorexia. Namely, a patient may lack the ability to acknowledge her disease or view her condition objectively. Her situation differs from that of a cancer patient because this psychological phenomenon is a component of her condition. In the case of anorexia, the patient’s opinion on the urgency of her condition is not always clear (Tan et al., 2006). Even if she comprehends her clinician’s explanation of her risk of fatality by anorexia, she may not agree that her own situation is life-threatening; there is a mismatch in applying her cognitive understanding to her own struggle (Tan et al., 2006). If a given patient with anorexia often does not recognize that a problem exists, lacking awareness of her disorder as it presents itself in her life, how can she make an informed decision about treatment based on her comprehension of relevant risks?
One might respond to this argument by noting that patients with many different health problems frequently deny when they are ill as a coping mechanism, so why should we consider patients with anorexia as lacking decision-making capacity? On the other hand, refusal to admit the reality of one’s disorder should be distinguished from cognitive reappraisal of one’s circumstances. Although many sick persons use denial to deal with challenging diseases, rejection of illness characteristic of anorexia is part of the condition anosognosia, which involves impaired physiological functioning of the right hemisphere of the brain (Torrey). In an article for an eating disorder treatment organization called the Kartini Clinic, author Julie O’Toole explains how anosognosia entails that “the brain does not perceive the extent of the illness, sometimes not even its presence” (2011). The term has been defined as “failure to systematically gather, integrate, and retain the relevant information, or failure to make use of the information to draw an obvious conclusion” (Rinn et al., 2002, pg. 55). A patient’s refusal of treatment in this case clearly reflects more than patient obstinacy. How can we justifiably give such a patient the right to deny herself treatment when anosognosia constitutes “a feature of anorexia” (O’Toole, 2011)? By its very nature, her condition may prevent her from truly understanding the presence of an eating disorder in her life, obstructing her ability to fully weigh her treatment options.
It is also important to consider that not all patients with severe anorexia have anosognosia. Other reasons for treatment refusal may include beliefs about the ineffectiveness of treatment due to previously unsuccessful hospitalizations, lack of motivation to be treated, time commitment of the program, or religious reasons. Interestingly, patients with anorexia often make rational judgments in other areas of life and even pass standardized competence exams, displaying “global competence” (Matusek and Wright, 2010, pg. 444). Researchers Stephen W. Touyz and Terry Carney noted that a patient’s decision-making ability depends on how well she can “grasp, retain, weigh and rationally process information,” regardless of how reasonable or compliant her choice may be; thus the clinician has a responsibility to adhere to her wishes (Touyz and Carney, 2010, pg. 6). Though most patients with anorexia display adequate judgment skills in areas of their lives such as occupation and education, this is not the case for issues concerning their own body, food and health (Matusek and Wright, 2010, pgs. 443-4). If relevant decision-making faculties are important prerequisites to exercising the right of autonomy, then we should hesitate in emphasizing the principle of self-determination in our consideration of involuntary treatment of persons with mental disorders like severe anorexia. It does not seem morally justifiable for a clinician to endorse patient refusal of care for the sake of respecting the patient’s autonomy when the disease undermines her present and “specific competence” (Matusek and Wright, 2010, pg. 443).
We now turn to (B) to evaluate the validity of protecting the future autonomy of someone with severe anorexia. Should we recognize her life-shaping decisions as representative of her actual wishes, or should these choices be treated as induced by the eating disorder? In other words, would accepting the patient’s goals of the moment truly be accepting those of the disorder? If the patient’s ability to reject care is questionable due to the nature of anorexia, the objective of treatment is in part to fully give her back decision-making capacity with regards to her health. This claim raises the moral question of violating autonomy as it appears in the form of explicitly-stated volition with the intention of replenishing it later on. (B) considers first how anorexia acts as a coercive factor in the patient’s choice to refuse necessary care, followed by an investigation of how hospitalization seeks to reestablish her self-determination and independence from the eating disorder.
Since the nature of anorexia involves an unattainable ideal of thinness and an altered perspective of health and body, we might consider the patient’s denial of her present condition as imposed by her eating disorder. This notion conceptualizes her refusal of treatment as a reflection of the eating disorder’s will, per se, rather than her own. According to an American Journal of Psychology article, the heart of anorexia involves the controlling influence of specific “overvalued beliefs” rather than an obsessive-compulsive or psychotic issue (Andersen, 2007, pg. 10). The fear of gaining weight is associated with this consumptive view of “fatness” that may even reign over religious commitments such as accepting Host during Catholic Mass (Andersen, 2007, pg. 10). The strength of her disordered beliefs may be sufficient to damage her perception of what is deeply important to her. In summary, the patient’s explicit wishes may be contrary to the values she prioritized before her disorder progressed. Therefore, adhering to her expressions of treatment rejection seems to give in to the eating disorder’s potency. If the patient’s illness acts as a coercive force in her decision to refuse, the choice is not truly self-driven, so contradicting her outright wishes may actually defend her autonomous faculties as we understand them in a healthy mental state.
One response is as follows: If informal manipulation (e.g. assertion of preferences by a close friend) does not fall under the legal category of coercion, why should an eating disorder to do so? After all, voluntary patients might be subject to this phenomenon (Matusek and Wright, 2010, pg. 435). Additionally, it seems that interpreting an urge to starve oneself as bullying or persuasion may open the door for any distressing, troubling thought to be considered sufficiently forceful to compromise autonomy. However, in the case of anorexia, coercion is unique in that it constitutes an internal element of the illness. The patient is aware that the consequences of her behaviors will likely lead to death, and although the desire to end her life is not a given characteristic of anorexia, her behaviors contradict her volition to continue living (Matusek and Wright, 2010, pg. 444). Namely, she rejects essential nutrition for survival and may also engage in dangerous purging behaviors with the use of laxatives or diuretics to eliminate consumed food (Andersen, 2007, pg. 10). Given our understanding of the illness, anorexia seems to act as a coercive force insofar as it coaxes the patient to understand her situation in a specific, distorted way.
To some extent, compulsory care actually seeks to defend the patient’s rightful autonomy, liberated from the disorder’s imposition of values. Autonomy is not simply a matter of explicitly stated wishes. Rather, it deals with a patient’s right to make decisions regarding her health. Although we cannot guarantee that a patient with severe anorexia will provide consent after the initiation of care, it is important to recognize that treatment strives to restore autonomy, returning the patient to a physically and psychologically stable state free of the disorder’s grip. Touyz and Carney argue that the probability of “retrospective consent” legitimizes use of coercion by a medical professional (Touyz and Carney, 2010, pg. 6). Although this view is quite extreme, it is important to recognize that involuntary patients sometimes acknowledge the importance of treatment and express gratitude for compulsory aid. In a Guarda et al. study (2007), around half of the hospitalized eating disorder participants who initially refused treatment admitted its necessity given their condition after only two weeks of being in the hospital (Guarda et al., 2007, pg. 108). In another study, post-hospitalized involuntary patients explained how they had adjusted their appraisal of compulsory care compared to before; they eventually identified the urgency and effectiveness of treatment (Watson et al., 2001). Although this research certainly does not guarantee a patient’s consent after-the-fact, this example illustrates that involuntary hospitalization does not necessarily ignore the goals and values she holds in a physically and mentally stable state.
An objection asks: is anorexia unique in this respect? Treating this disease as such seems to justify involuntary hospitalizations for a slew of illnesses, including many mental disorders, simply on the basis of clinician judgment. In the case of severe alcohol abuse, for example, cognitive issues involved in the disease have been linked to addiction denial (Rinn et al., 2002, pg. 52). However, although anorexia and alcohol addiction both may undermine judgment with respect to health, a comprehensive argument for the moral imperative to treat involuntary patients with severe mental illnesses such as substance abuse disorders is beyond the scope of this investigation. A convincing argument for compulsory care requires an additional analysis of the effectiveness of treatment methods in restoring cognitive functioning and physical well-being. It should be noted that clinician judgment is indeed crucial in determining the nature of a patient’s condition. The “doctor’s orders” are legitimate insofar as they reflect extensive knowledge of the patient’s history, thorough investigation into treatment options, and urgent corroboration by other experts.
In addition to the issue of upholding the patient’s volition, justifying compulsory treatment calls for an assessment of the potential outcomes of care. Traditionally, violating a patient’s declared wishes requires a cost-benefit assessment of the harm in restricting her autonomy versus the benefits of hospitalization. However, this conceptualization of the moral issue fails to consider the psychological complications of anorexia and thus the manifestation of beneficence in this context due to its blind defense of present autonomy. If her illness undermines her decision-making faculties with regards to her health care, and respecting her explicit desires does not truly respect her autonomy, we must place less emphasis on respect for the patient’s expressed inclinations regarding hospitalization. The moral issue of compulsory treatment thus focuses on an assessment of the physical and mental benefits and consequences of forcing a patient into treatment.
The first priority after detaining a patient with severe anorexia is returning her to a state of physical stability. According to the National Eating Disorders Association, when her body fights to provide her with energy she does not consume from food, she struggles with health consequences such as decreased heart rate, dehydration, possible liver failure, reduction of muscle mass and strength, weak bone density, and hair loss. This evidence of significantly diminished quality of life resulting from her illness indicates that effective treatment may be admirable when it successfully safeguards her well-being. If acting beneficently toward a patient with anorexia involves minimizing her suffering, and if her condition is salvageable and she does not seek to die, involuntary hospitalization may provide a route to sparing her from further harm induced by the illness.
In our case, adequate care involves life-saving measures, and these measures have had success in the past. In fact, several notable studies concluded that compulsory treatment was beneficial to patients’ recovery at least in the short-term. In one by Ramsay et al. (1999), both voluntary and involuntary anorexia patients who participated in the experiment gained weight after treatment. The former group increased by an average of 11.0 kg (~24 lbs.) in 88 days and the latter by 12.1 kg (~27 lbs.) in 133 days (Ramsay et al., 1999, pg. 151). Although the compulsory care group took almost two months longer to reach a healthier weight, these patients still successfully reversed their deprived physical state. Another study observed that involuntary patients regained weight at the approximately the same rate as voluntary (2.6 and 2.2 lbs. per week respectively) (Watson et al., 2001). When she receives care that will improve her severe yet reparable condition, a patient with anorexia has a strong chance of success regardless of her attitude prior to admission.
Despite the optimistic results of these treatment tactics, not all research supports their efficacy, especially in cases of involuntary admission. In terms of physical health, the accomplishment of short-term weight gain does not seem worthwhile unless the healthy body mass is maintained over time. In Ramsay’s study, mortality was significantly higher in involuntary than voluntary patients after an average of 5.7 years in treatment (12.7% versus 2.56%, respectively) (Ramsay et al., 1999, pg. 150). Forced treatment may result in decreased risk for survival in association with the greater number of prior admissions of involuntary patients. However, Ramsay inferred that the necessity of forced treatment did not simply arise out of low BMI but rather the severity of the condition combined with refusal to acknowledge this (Ramsay et al., 1999, pg. 151). Although some other long-term studies have been conducted, more are necessary to determine how these patients recover in the years following hospitalizations (Watson et al., 2001). The nebulousness of actual results raises doubts as to whether compulsory treatment is justifiable given the patient’s outright refusal and uncertain long-term outcome.
On the other hand, if the principle of autonomy involves more than simply respecting the right to explicitly refuse, we are left with the fact that, without an attempt at treatment, she will likely die. Assuming that thorough clinical evaluation has established that the patient’s condition be salvageable, and that her eating disorder clearly not be terminal, it does not seem right to allow her to refuse treatment that has strong potential to return her to a physically and mentally stable state.
Health improvements during hospitalization bring into question how long a detainment period is morally acceptable before treatment infringes on patient rights to self-determination. At what point should she have the autonomous right to leave the hospital as she regains physical health? To justify goals of treatment, mental health care must also be required as an extension of involuntary hospitalization. After all, restoring the patient’s weight does not imply release from the grip of her eating disorder whether or not she voluntarily sought out intensive care initially. From an ethical perspective, it does not seem reasonable to treat the patient’s physical condition if self-starvation will persist upon release from the hospital; saving her life in the short-term holds more value if treatment methods are likely to make lasting improvements.
In addition to considering physical health outcomes of compulsory care, we also must assess the impact on the patient’s mental state. Even if the patient’s body weight is within a healthy range, and her brain has more nutrients to function, she may still struggle with psychological issues related to her eating disorder, such as intense urges to restrict food consumption. In some cases, compulsory care exacerbates the patient’s disorderly behaviors and attitudes post-treatment rather than reducing them. Examples might include attempts to lose weight gained in the hospital, increased suicidal inclinations, or reduced probability of reaching out for necessary aid in the future (Matusek and Wright, 2010, pg. 439). In one study, Theils (2008) investigated 25 women ages 16 to 39 with potentially fatal anorexia who were admitted to the hospital and received treatment in the form of normal meals, supplements and feeding tubes in some cases (Touyz and Carney, 2001, pg. 8). Researchers observed that some patients rebelled against the care team, adjusting their feeding tubes and making comments such as, “So far I have beaten everybody and have not put on weight.” (qtd. in Touyz and Carney, 2001, pg. 15). A strong objection to compulsory treatment asserts that the risk of increasing the patient’s suffering (i.e. by submitting her to apparently coercive measures and fighting the eating disorder too aggressively) exceeds the likelihood of salvaging her condition (i.e. achieving physical stability and psychological well-being). After all, the medical community could instead be exerting time and effort on patients with a greater chance of long-term survival. This argument contends that it is not morally acceptable to force treatment simply because the condition is life-threatening. Further, any attempt to help her condition is not automatically more moral than none.
In addition to providing the medical assistance necessary to save her life, compulsory treatment of a patient with severe anorexia nervosa may defend her values and goals as would be expressed in a physically and psychologically stable state. One should not fall under the guise of defending a patient’s explicitly-stated refusal when, in reality, anorexia often constrains her capacity to see beyond illness-imposed views of health and body.
Although these claims raise valid questions, they neglect the importance of variability in treatment programs’ methodologies and conduct. In Theils’ study for instance, we cannot discount the importance of care center atmosphere in influencing health outcomes (Touyz and Carney, 2001, pg. 15). Quality of treatment becomes a dramatic factor in assessing clinician beneficence since we consider compulsory treatment obligatory insofar as the patient’s condition can improve. To require detainment of a patient with life-threatening anorexia, there must be a standard of supportive, effective patient-staff interaction. Compassionate yet assertive treatment methods seem to be the strongest combat to the eating disorder. For instance, shame associated with consuming food may be relieved when staff members oversee patient meals and require compliance (Matusek and Wright, 2010, pg. 439). In addition, motivational interviewing and other cognitive-behavioral therapy methods may decrease patient stubbornness arising from the sense of being stripped of autonomy (Matusek and Wright, 2010, pg. 438). With a caring, conscientious staff focused on preserving the patient-clinician relationship, therapy as a necessary requirement of compulsory treatment helps legitimize long-term hospitalization. After initial admission, preventing her disorder from regaining control and interrupting her life must be a priority if treatment truly promotes her best interests. When she receives immediate, intensive and benevolent aid with lasting results, detaining and caring for an involuntary patient with anorexia is both morally defensible and mandatory.
In addition to providing the medical assistance necessary to save her life, compulsory treatment of a patient with severe anorexia nervosa may defend her values and goals as would be expressed in a physically and psychologically stable state. One should not fall under the guise of defending a patient’s explicitly-stated refusal when, in reality, anorexia often constrains her capacity to see beyond illness-imposed views of health and body. Such considerations may be relevant to diseases such as substance abuse disorders, when certain relevant cognitive abilities are often undermined. If thorough clinical evaluation establishes that a patient’s condition has the potential to improve, involuntary hospitalization and subsequent treatment of anorexia is not only the most compassionate option but also morally obligatory.
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