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Debate: Anorexics, force-feeding of

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Should the medical profession force-feed anorexics as part of their treatment?

Background and context

Anorexia Nervosa is an eating disorder defined as severe, self- inflicted starvation and loss in body weight to at least 15% below that expected for the individual’s sex and height. In the UK (and many other western countries) anorexia nervosa is classified as a mental illness. Anorexia nervosa should not be confused with Bulimia (cycles of bingeing and vomiting). Anorexia is typically associated with women and body image and is thought to be made worse by unrealistic media portrayals of the female body. Having said this, one in ten sufferers is male. Mortality varies between 5% and 18%. Anorexia nervosa has been detected in patients from 6 to 76 years of age and has a far higher incidence in the Developed World, affecting 1% of female adolescents.Patients who are dangerously thin are sometimes force-fed through a naso-gastric (through the nose) tube. Normally, medical treatment cannot be administered without the consent of the patient, however, in the case of mentally ill patients, their distorted perceptions of reality may render them unable to make a choice. Despite this, medical ethics, pragmatics and human rights call the treatment into question.[1]

Contents

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Legality and rights: Is the force-feeding of anorexia patients legal?

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Yes

  • Anorexics are typically treated under mental health legislation (e.g. the UK 1983 Act): They do not make a free choice because they are not rationally able to weigh up decisions and consequences. The patient is not “capable of forming unimpaired and rational judgements concerning the consequences” (British Medical Association 1992).[2]
  • Medical ethics say that a doctor has a responsibility to keep the patient alive to administer treatment: In the UK Diana Pretty was denied the right to die by the House of Lords even though she consistently request it. The Israeli Courts ordered the force- feeding of political hunger strikers arguing that in a conflict between life and dignity, life wins. India prosecuted a physician who allowed a hunger striker to die. The medical profession take their responsibility for life very seriously on a global level.[3]
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No

  • Force feeding is undignified and thus illegal: The European Convention on Human Rights prohibits “degrading” treatment in Article 3. The patient’s right to refuse treatment should be respected even if they are mentally ill.(N.B. Anorexia is not recognised as a mental illness in every country).[4]
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Treatment: Is the force feeding of anorexia patients necessary as a way to treat the illness?

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Yes

  • A healthier body weight is necessary to be able to treat the patient’s psychological problems: Studies in Minnesota show that when normal volunteers were starved, they began to development anorectic patterns. They over-estimated the sizes of their own faces by approximately 50%. This shows the impact of starvation on the brain.[5]
  • Life is more important than dignity in the case of force-feeding anorexics: Many medical treatments are unpleasant or painful but they are necessary to preserve life. Psychological problems can only be treated if the person is alive.[6]
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No

  • Compulsory treatment may only be successful in the short term: In the long term it does nothing to reduce the fear of food, weight and hospital felt by the patient and is a barrier to treatment. Suicide accounts for 27% of anorexia deaths. Compulsory treatment may make the patient more depressed and at greater risk from harm.[7]
  • An anorexic’s fear of weight gain, especially forced weight gain in hospital is an obstacle to treatment: If an anorexia sufferer thinks that they will be force- feed they may be less likely to seek treatment or advice.[8]
  • Force-feeding of anorexic patients can be risk the patient's health: If the patient is dangerously thin and is then force-fed, it can led to Hypophosphataemia (reduction of phosphates in the blood) which causes heart failure.[9]
  • Risk of force feeding may cause anorexics to avoid treatment: Anorexics are characterised by self-denial and often do not come forward voluntarily. They are even less likely to do so if they are faced with the possibility of force- feeding.[10]
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Palliative care alternative: Is the palliative care of anorexics an insufficient alternative?

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Yes

  • Palliative care is defeatist and does not attempt to cure the problem: Doctors do not often have to deal with severe or chronic anorexia. Just because it is a very long treatment schedule that can be harrowing for a doctor, this not a reason to settle for palliative care. Better support structures ought to be put in place to enable the doctor to fulfil their obligation to the patient.[11]
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No

  • Some doctors advocate focusing on palliative care (relief of pain but not treatment of cause) due to the low full recovery rates of anorexia sufferers: Research Studies Show that over 10 years only approximately 20% of patients recover. Those patients who are sufferers for more than 12 years are unlikely to ever recover.[12]

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