Are Ultimatums About Eating Disorder Treatment Ever Ethical

Concurrent with the idea of full recovery is the concept of clinicians giving patients ultimatums about recovery if they are not “fully committed.” At what point is it ethical for a clinician to stop working with a patient because that person is not making progress? Is that decision ever ethical?

When the idea of full recovery is a therapeutic goal, the bar for treatment is set very high with rigid parameters for success. In this paradigm, only people who are committed to recovery, willing to adhere to a meal plan and show up regularly to do the emotional work are acceptable as patients.

However, eating disorders are psychological illnesses with medical consequences which can be severe or even life threatening. Ambivalence about getting well, fear of losing the emotional support provided by the disorder and body image distortion all make recovery very challenging to contemplate, let alone to remain steadfastly committed. Even if the medical consequences frighten clinicians, the professionals need to ensure the safety of the patient and have enough support to feel comfortable doing their jobs.

Any realistic treatment needs to take into account the ups and downs of treatment and the times someone may slip backwards. The vagaries of recovery don’t disqualify people from clinical care, no matter the medical severity. I don’t believe it is ever right to end care without an acknowledgment that the clinician is a part of what isn’t working and with a clear transition to a new treatment team.

But what about the people unable to keep moving forward? What about those in need of emotional support who don’t have the wherewithal to commit to getting well at all? Should they be discarded as if they don’t deserve care? Should they be punished for the severity of their illness?

No matter how one answers these questions, the reality is that many of these people are dropped by providers because they are supposedly not committed enough to treatment. Clinicians should be able to admit the case may be too difficult to manage. The onus is on the clinician to admit their limitations, not blame the patient, and find alternative care. Setting an ultimatum a patient can’t reach only exacerbates the shame already baked into any eating disorder.

Kindness and compassion are necessary components of any recovery. Creating more shame due to supposed clinical ethics is only cruel.

These concepts of “full recovery“ and the “ethical” decision to drop patients both need to reassessed. It’s clear to anyone trying to treat people with eating disorders how difficult that work can be. Clinicians need to own their limitations, set reasonable goals for recovery for each patient and be sure to approach every interaction with kindness and compassion to the best of their ability.