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

Abstract

Background This study investigated the attitudes of physicians in Japan, the United Kingdom (UK), and the United States (US) toward refusal of treatment for anorexia nervosa. Methods A questionnaire survey was administered to physicians treating patients with eating disorder (Japan, n = 55; UK, n = 84; US, n = 82) to evaluate their treatment strategies for fictitious cases of refusal of treatment for anorexia nervosa. Results For acute patients, 53 (96.3%) physicians in Japan, 65 (77.4%) in the UK, and 54 (65.9%) in the US chose compulsory treatment if the patient’s family requested treatment, while 46 (83.6%) physicians in Japan, 53 (63.1%) in the UK, and 47 (57.3%) in the US chose compulsory treatment if the family left the decision to the patient. For severe and enduring anorexia nervosa, 53 (96.3%) physicians in Japan, 62 (73.8%) in the UK, and 57 (69.5%) in the US chose compulsory treatment if the patient’s family requested treatment, while 38 (69.1%) physicians in Japan, 56 (66.7%) in the UK, and 55 (67.1%) in the US chose compulsory treatment if the family left the decision to the patient. Conclusions Physicians in all three countries tended to choose compulsory treatment irrespective of disease duration or whether the patient’s family requested treatment or not. This may indicate that medical practitioners value the ethical obligation of beneficence, giving priority to the protection of life. Attitudes toward refusal of treatment during a life crisis tend to vary among medical professionals, particularly if the patient’s family does not request treatment.

Involuntary Treatment for Child and Adolescent Anorexia Nervosa—A Narrative Review and Possible Advances to Move Away from Coercion

“…While emphasizing patient autonomy and offering choices within treatment settings have shown potential to increase compliance and promote feelings of control and self-efficacy among patients with AN [32,35], the need for empirical data to understand the consequences and the potential harm of IVT in AN is essential. Suggestions for guidelines based on such empirical evidence are warranted, as in addition to varying legal preconditions, the attitudes and choices of physicians vary widely based on individual factors and knowledge of the disorder [36].…”