Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision‐making

Abstract

Ethically problematic situations frequently arise in the care of children and adolescents with eating disorders. The younger person with anorexia nervosa can often deteriorate quickly, therefore the child who is in denial with respect to the seriousness of her condition and/or markedly ambivalent regarding renourishment is at grave risk. Involuntary treatment is likely to be a consideration during such a medical crisis. In this paper we outline an ethical decision-making framework that can assist the clinician in engaging the young patient and her family well in advance of a crisis, so that decisions can be made at a time when recourse to establishing incompetency or enforcing involuntary treatment are unnecessary. We have adopted a narrative approach in our application of the decision-making framework, and safety is emphasized as the central concept underlying the application of this model. Finally, a number of recommendations are made regarding application of the ethical decision-making framework with younger persons.

The place of inpatient care in the treatment of anorexia nervosa: Questions to be answered

“…Ideally, the decisionmaking should be a participatory process involving the patient and her family, with complete transparency of the rationale for the proposed treatment, and reflecting a genuinely caring approach to reach a fair decision. It will make a tremendous difference if the hospitalization is perceived as a supportive component of the recovery process and not as evidence of failure on the part of the patient, the family, or the therapists (Manley, Smye, & Srikameswaran, 2001;Vandereycken, 1987). In case of protracted but fruitless outpatient therapy, the patient ''may perceive the recommendation for hospitalization as a threat or as abandonment, but should be reassured that it is a humane alternative to the tremendous emotional and financial expense of prolonged and unproductive outpatient therapy'' (Garner & Needleman, 1997, p. 54).…”

Decision Making in Paediatric Care: an overview with reference to nursing care

“…At the age of 12, children are usually considered to understand the implications of the process of informed consent. 18 Children and adolescents have different developmental capacities compared with adults. They differ in their perceptions of benefits and risks, which makes consent difficult, and they are also less resistant to social influence and affected by the opinions of parents, family members and hospital staff .…”

Adolescent inpatient treatment for anorexia nervosa: a qualitative study exploring young adults' retrospective views of treatment and discharge

“…In particular, prioritizing problem behaviours over emotional or psychological needs was seen as unhelpful, as was failure to take a genuinely holistic approach that included the needs of other family members. The potentially negative impact of 'labelling' patients as 'anorexic' has been highlighted previously (Eivors, Button, Warner, & Turner, 2003;Manley, Smye, & Srikameswaran, 2001). In the current study, when patients felt perceived as a unique individual; one who was valued and supported with psychological as well as other treatment, and when families were supported, a much more positive view of the inpatient stay emerged.…”