Decisions about Treatment for End-Stage Eating Disorder Patients

The legal component of mental health treatment is complex and has no easy answers. That is compounded several times by the decisions around end-stage eating disorder care. 

The medical complications of eating disorders are often life threatening. At the most severe stage of illness, multiple organ compromise or failure is common, but successful treatment eludes even the most experienced physicians who aren't knowledgeable about these diseases. Consequently, end-of-life care is often very poor. 

Usually, at this stage of any illness, the patient has some awareness of the medical situation and can either express their wishes or has already stated them prior to becoming so compromised. That is often not the case with eating disorder patients. 

The severe state of malnutrition typically strengthens the eating disorder thought process, so many patients in danger of losing their lives cannot understand the severity of the situation. The eating disorder mindset becomes so ingrained at that stage of illness that any other way of thinking is incomprehensible, even when physicians clearly explain the dire consequences. Moreover, the family is usually aware of the fact that it has been years since the patient felt that any change was possible, if ever. 

Ethically, what is the family to decide and what can physicians do? Emergency medical intervention, even against the patient's wishes, can save her life in the short run. However, long-term forced treatment has proven time and again to be counterproductive and only intensifies the grip of the eating disorder. Families can acquire the legal power to make decisions for their adult child but to what end?

These questions highlight the challenges of how to help such a severely ill person with an eating disorder in a life-threatening stage of the illness. The answers are all unsatisfactory, and the outcomes all look bleak. 

If the family can work with the patient and doctors to all agree to life-saving medical care then that is a reasonable first step. But pressing further treatment only feels like a prison sentence to any patient. Accepting the limitations of current treatment options is a crucial part of medical decisions making once a patient has multiple organ compromise.

Kindness, compassion and understanding can have a significant impact even in the most dire cases. Sometimes, getting very ill, as awful as that is for the patient and family, can open the door to a new path of recovery.

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