The medical community still struggles enormously to know how to help patients with severe, life-threatening Anorexia Nervosa. Often, hospitals, even ones with experienced doctors, can medically stabilize at best. Residential treatment programs have no long lasting treatment approach to offer other than months of nutrition with the hope that the eating disorder thoughts abate. The field has studied medication after medication to no avail. Various outpatient programs find that harm reduction and long-term medical stabilization are most often the best outcome.
Ethically, the field is often torn between bad outcomes and worse ones. Patients often respond by living outside the medical system and trying their best on their own or with one provider compassionate enough to stand by them and accept the severity of their illness.
Is a life of chronic illness often without much ability to have a satisfying, fulfilling life worthwhile? Should patients be found mentally incapable and given a legal guardian to force them into treatment even if they are otherwise totally lucid? Are these patients sometimes in a situation worth considering ending one’s own life as Dr. Jennifer Gaudiani wrote about publicly a few years ago?
These questions represent only part of the ethical dilemma swirling around the treatment of these patients.
Over the years, I have written multiple times in this blog about the mental health provider’s obligation to stand by these patients and support them them even in difficult situations. Too many of these patients end up abandoned by their providers—typically out of fear of the illness or liability or both. That’s not an acceptable option either.
The hope is that the field will find new ways to successfully treat Anorexia. Every new drug or new therapeutic approach ends up being tested for Anorexia, thus far to no avail.
I still believe these patents deserve support and deserve a voice. It can be very hard to do so when medical doctors don’t feel equipped to treat them, when family and practitioners often feel overwhelmed or afraid of their appearance and when treatment options are so limited for a dire, potentially life-ending illness.
Medicine tends to approach these patients on a case by case basis without clear guidance on a treatment protocol. Even seasoned ethicists struggle to find the right path. Patients rights bump up against a severe and largely misunderstood illness. There are no right answers.
Even though I come down on the side of patients rights, I’m aware that the choices are limited. The only answer is to find a path towards improved health, not even a cure at this point. It’s a painful and challenging reality for people with severe Anorexia. But that’s where the field is right now.
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