Anorexia and Forced Hospitalization

Anorexia Nervosa and Forced Hospitalization

Jessica Peluso

Should a physician be allowed to hospitalize a patient suffering from anorexia nervosa against his/her will? Anorexia nervosa is a multifactorial psychiatric disorder that manifests as a very low body weight and distorted body image. More than 90% of the cases are seen in young women (typically teens to young adulthood). Long term mortality can be as high as 10% resulting from starvation, suicide or electrolyte imbalance.

Consider a young teenage girl (18 y/o) whose mother has come to you requesting your assistance in dealing with her malnourished child. The patient is described as a 5’6”, 75 pounds who was 120 pounds six months prior. The patient’s lab work reveals some electrolyte disturbances. However, the patient denies that she is anorexic and is refusing any treatment.

Of course the problem arises in determining whether autonomy should supersede beneficence. This can be a very difficult situation because the patient is refusing treatment and to enforce her into something she is unwilling to do would infringe upon her ability to exercise autonomy. However, the patient’s body (suggested by the lab work) and family are obviously crying out for help. Would it be considered assisted suicide if nothing was done to deter this behavior?

Unfortunately this situation was all too real for me and my family. I suffered from anorexia nervosa from 16-22 years old. During that time I dropped down to 75 pounds at my worst and was hospitalized three times many times with mixed emotions. I, too, never admitted to being anorexic and many times my hospitalizations provided me with ways of becoming a “better” anorexic. The fear of gaining weight was real. More importantly, though, gaining weight was a fear greater than just pounds. The fear of gaining weight for me, as for many others, meant giving up control. It was not until I learned about a “miracle” named Madelyn (my first child) that I decided to deal with this life threatening issue.

I can honestly say that I believe that the physician should have the ability to exercise his /her judgment in these situations to promote life even if it means sacrificing the patient’s autonomy. I can say that when I was wrapped up in this disease, my state of mind was altered as I believe many of these patients with similar situations are. If the provider does nothing, I believe we are allowing suicide to occur in front of our eyes. Even if it means multiple hospitalizations, I believe, life needs to be promoted so that hopefully, eventually, these patients may also be given a chance for a “miracle”.

References:

http://www.cpa-apc.org/Publications/Archives/CJP/2002/april/briefCommunicationTreatmentResistance2.asp (Accessed 10/06)