When Does the “Duty to Protect” Apply with a Client Who has Anorexia Nervosa?

Abstract

Individuals with eating disorders, especially those with anorexia nervosa, have the potential to experience significant harm and even death as a result of behaviors related to their condition. Because of this risk, the authors argue that there is a duty to protect (i.e., an obligation to take some action when a person is engaging or considering engaging in a behavior that may lead to self-harm) when a client's anorexia-related behavior has progressed to the point of medical jeopardy—that is, her or his life is in danger. This article reviews information on anorexia, including mortality data; ethical and legal issues when a client is believed to be a harm-to-self; and the literature related to involuntary hospitalization and compulsory treatment of clients with anorexia. The article concludes with a set of guidelines for when the duty to protect when a client has anorexia nervosa begins and with suggestions for interventions.

Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision‐making model

“…According to some professionals' interpretation, the ethical guidelines and code require clinicians to take action when a client's eating disordered behaviours have progressed to the point of life endangerment regardless of the client's expressed wishes (Griffiths & Russell, 1998;Werth, Wright, Archambault, & Bardash, 2003). Self-destructive clients at risk for significant self-harm generate concerns of paternalistic treatment (Rathner, 1998).…”

“…Mental health professionals advocating for voluntary and involuntary inpatient treatment of clients with severe eating disorders argue that the structure and close monitoring is necessary to break eating disordered habits and form healthier habits (Bentovim, 2000;Werth et al, 2003). Evidence from Watson et al's (2000) study of an inpatient program suggests that involuntarily admitted clients experienced similar short-term rates of weight gain relative to those who were admitted voluntarily.…”

“…Such assessments are made by medical doctors and skilled nurses but clinicians need to be well-versed in warning signs and collaborate with professionals from other disciplines to offer the best standard of care. In addition to collaborating with allied health professionals, clinicians may intervene to protect a client if she is unable to manage behaviours which have the potential to cause her significant damage or death (Werth et al, 2003). In other words clinicians have the right to initiate the appropriate level of care under the auspice of grave disability and a psychiatric disorder even if there is no expressed intention to die.…”

“…In particular, anorexic clients suffering from the effects of starvation may struggle with impaired reasoning and cognitive abilities (Werth et al, 2003) which may impede their ability 'to appraise their condition rationally or shift to other patterns of thought and behaviour' (Vitousek, Watson, & Wilson, 1998, p. 393). Cognitive impairments can affect judgment and decision-making when a client with AN experiences cerebral pseudoatrophy and/or biochemical changes as a result of nutritional deficiencies (Vitousek et al, 1998).…”

Anorexia nervosa in adolescents: Responding using the Canadian Code of Ethics for Psychologists.

“…In these cases, it is fairly clear that the patient may be admitted to hospital and treated, whether or not he or she feels the process to be coercive. In the past, individuals with eating disorders (EDs) were helped by clinical psychologists or psychiatrists; they are now being treated in a variety of settings and by a variety of professionals, including counselling psychologists (Werth, Wright, Archambault, & Bardash, 2003). A psychologist's assumptions about the need for involuntary treatment could depend on whether or not the psychologist has had experience with the more severe range of the spectrum of EDs (Andersen, 2007).…”