Ethical re-evaluation of contemporary treatments for anorexia nervosa: Is an aspirational stance possible in practice?

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

“…The proponents of compulsory treatment claim that most clients originally resistant to involuntary treatment come around to be very thankful for the insistence of their caregivers and would want to be treated in a similar fashion again (Goldner, 1989;Goldner et al, 1997;Griffiths & Russell, 1998;Honig & Bentovim, 1996;Russell, 1995;Serfaty & McCluskey, 1998;Watson et al, 2000). However, this argument has been largely anecdotal and dismissed by some professionals because it violates principles of autonomy and informed consent (Carney, Tait, Touyz, Ingvarson, Saunders, & Wakefield, 2006;Fedyszyn & Sullivan, 2007).…”

“…In recent years, the claim that compulsory treatment irreparably impairs the therapeutic alliance and undermines the likelihood of seeking future treatment (Dresser, 1984a;Giordano, 2005;Lanceley & Travers, 1993;Richmond, 2001) has gained increased attention (Fedyszyn & Sullivan, 2007) and empirical support (Vandereycken & Vansteenkiste, 2009). Two studies (Guarda et al, 2007;Vandereycken & Vansteenkiste, 2009) published to date have empirically investigated clients' perceptions of coercive treatment for eating disorders.…”

“…In terms of conflicting ethical principles, clinicians are bound by their duty to protect the health and welfare of clients when clinicians know that their clients are in imminent danger of dying or in serious, irreversible medical danger. On the other hand clinicians are obligated to respect clients' autonomy, their wishes regarding treatment, and to use the least restrictive interventions possible (Bentovim, 2000;Fedyszyn & Sullivan, 2007;Macdonald, 2002). Just because a proposed treatment stands to benefit an eating disordered client is not a sufficient reason to impose treatment.…”

“…Furthermore, the empirical evidence has demonstrated limited efficacy of available treatments and the ineffectiveness of forced feeding to cure an eating disorder (Fedyszyn & Sullivan, 2007). Working from the principles of beneficence and non-maleficence, it only makes sense to enforce treatment if one is reasonably confident that the treatment will bring about benefit to the client (Carney et al, 2006;Dresser, 1984b;Mitchell et al, 1988).…”

“…Issues of justice include ensuring equal access to psychological services, respect for human rights, client dignity, and limiting unreasonable and unfair treatment (Rosenman, 1998). Just treatment for clients with eating disorders involves using the least restrictive intervention to ensure client safety and promote good treatment outcomes (Fedyszyn & Sullivan, 2007).…”