Anorexia: A Role for Law in Therapy?¹

International comparison of physicians’ attitudes toward refusal of treatment by patients with anorexia nervosa: a case-based vignette study

“…The results also indicated that the tendency to choose compulsory treatment differed significantly among physicians in all the three countries. Refusal of treatment in life-threatening cases of malnutrition poses the ethical dilemma of whether the physician should prioritize the protection of the patient's life or the patient's right to self-determination [10]. From the perspective of the four principles of medical ethics [11], it can be analyzed as an ethical issue of comparative consideration between the principle of good conduct and the principle of respect for autonomy.…”

Social Work and the Ethics of Involuntary Treatment for Anorexia Nervosa: A Postmodern Approach

“…Whilst social workers in these settings may engage with patients in these settings as 'service users' or 'clients' (for example), in hospital psychiatric settings persons receiving treatment are constructed as 'patients'. 312 KENDALL AND HUGMAN Vandereycken 1998;Carney et al 2005Carney et al , 2006Carney 2009). The competence of the patient is central to this balance; involuntary treatment can be justified for patients deemed incompetent on the basis that it will protect them from harm until they are able to make a competent decision about their health care.…”

“…(2) Assessing the competence of the person to refuse treatment (in order to make a judgement that is respectful of their autonomy) is complicated by the issue that persons with AN who refuse treatment can usually make competent decisions about all aspects of their lives except for in relation to their nutritional intake (Carney et al 2003(Carney et al , 2005(Carney et al , 2006Carney 2009). Further, persons with AN who refuse or resist professional intervention are often at the same time very distressed by their condition (Tan & Hope 2008).…”

Capacity, value neutrality and the ability to consider the future

“…However, proposals to abandon mental health laws raise the question of whether a legal structure based on the concept of mental capacity, with its value-neutral approach, would sufficiently allow the state to intervene paternalistically in cases of psychiatric illness. Contexts in which patients could be judged to have mental capacity but are arguably not in a position to be making those decisions have been highlighted in anorexia nervosa (Tan, Hope, Stewart and Fitzpatrick, 2006 ; Hope, Tan, Stewart and McMillan, this issue; Carney, 2009 ) and mood disorders (Rudnick, 2002 ; Elliott, 1997 ). In the background is a long-standing debate about whether standard tools for assessing mental capacity adequately capture the problems of decision-making that seemingly justify the transfer of a decision to a surrogate (see, for example, Charland, 1998 ; Appelbaum, 1998 ; Breden and Vollmann, 2004 ; Okai et al , 2007 ).…”