Refusal of life-saving treatment is a familiar topic for medical ethicists, but it has rarely been discussed in the context of psychiatric illness. A growing awareness that some psychiatric illnesses can be chronic, and extremely debilitating, has led to recent interest in this topic. However, ethical questions in this area are made complex by the fact that decision-making capacity in such patients is often contested.
The focus of this conference is severe and enduring anorexia nervosa. Anorexia nervosa is an illness that can persist for decades and is often associated with extremely low quality of life. Given that the odds of recovery become lower with the passage of time and that these patients genuinely suffer, might it make sense at some point to transition from a focus on cure to a focus on quality of life? Might it make sense in such cases to honor a patient’s desire to avoid hospitalization and/or forced feeding? If so, what else should we provide?
These are the difficult questions faced by clinicians who treat these patients. If we are to do our best for this patient population—if we are to offer compassionate care— we must carefully reflect on these questions.