Eating Disorders the Argument Regarding the Medical

Eating Disorders

The argument regarding the medical and ethical treatment of anorexia nervosa patients has been highly debated throughout the medical and philosophical circles. On the one side, there is the belief that doctors can only go so far before forced treatment and involuntary hospitalizations should be unethical. On the other hand, doctors have taken their oaths to do everything they possibly can to save a patient's life, even to the point of expertly deciding the fate of the patient, regardless of the patient's contrary decisions. The general argument -- pointed out by the likes of James L. Werth (2003) and Heather Draper (2002) -- lies in the premise that one inflicted with anorexia nervosa is incapable of thinking competently. This incompetency thus allows medical experts the ultimate decision of involuntarily hospitalizing the patient and/or subjecting the patient to a forced treatment for the disorder. Doctors alike have taken their respective oaths to protect and serve the clients to the best of their abilities, so long as the client is willing and fully aware of the impending methods.

In that line of thought, if the person suffering from said anorexia is proven to be mentally competent, how does one draw the line for medical experts to undergo an intervention? Once again, the question here becomes a matter of the patient's competence. A refusal for forced treatment or involuntary hospitalization should be determined on that competency basis. If the patient is fully aware of the consequences and is competently refusing treatment for her anorexia on a number of various grounds, then the attempt of a medical forced treatment would be unethical -- to the point where it is even a violation of the patient's rights (Draper, 2002). This forced treatment on a competent person would be akin to resuscitating a DNR signee. However, in all other cases where the person is clearly incapable of rational and competent thought over her disorder, the case of involuntary hospitalization and forced treatment should be an inevitable step in the medical and ethical direction.

That said, doctors are responsible for providing medical aid and protection to the best of their abilities. How far must one draw the line, however, before the patient is well beyond one's help (Werth, 2003)? After explaining to the patient and the patient has reasoned that her life is past help (owing to her extremely poor quality of life, constant hospitalization, and bodily failure), then surely here the doctor would be transgressing on dangerous ground should he or she continue with the treatment. The patient no longer desires treatment; the patient has moved past the stage of wanting to hold on, perhaps even to the psychological point that any treatment would result in a failure. The patient in this situation -- while acting upon a more aggressive reflex -- is competent. She does not want treatment, any more than a DNR individual does not want to be resuscitated after a failed operation. She wants to continue on her downward spiral. Any attempts to save her would only damage whatever therapeutic treatment is left. In this case, one would honor the patient's wish; if the patient no longer wishes to fight, then who is to say how successful the forced treatment will be? The patient's psychological condition is just as important, and that refusal in itself becomes a huge factor in treatment.

If the patient, however, continues to aggressively fight the treatment outright, but does not refuse treatment, then there is that chance that the patient is suffering a psychological deterioration. In this case, it would be more ethical to involuntarily hospitalize the patient for further medical treatment. In this case, patients usually become compliant and grateful after treatment has taken place (Werth, 2003). The person is incapable of making the proper rational decisions regarding nutrition, and the lack of nutrition has impaired the person's judgment (Werth, 2003). Because of this medical threat to the patient's life, the refusal to act upon it might be deemed unethical. It is, after all, the patient's life at stake, and saving it at extreme costs is the doctor's job. According to Werth, the "possibilities exist for involuntary hospitalization of person whose self-harm is not necessarily intentional but is the result of a mental disorder or grave disability" (2003).

However, this is where both Draper and Werth differ. Werth argues that suicidal tendencies within a patient with anorexia nervosa are subject to the doctor's duty to protect (2003). Draper, however, would undoubtedly state that this tendency could be a side-effect of a plethora of grievances experienced by a tired patient who has been continually hospitalized and pained by the forced treatment of the disorder (2002). Is this person, then, suicidal? Or just exhausted from the constant fight against the disorder? How, then, does one determine a person's competency in order to decide when to withdraw the duty to protect?