The Pursuit of Thinness and Involuntary Intervention : Can We Ever Justify the Use of Coercive Methods in the Treatment of Anorexia Nervosa ? RUTH DRURY
Extracts from a dissertation .
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ABSTRACT
The coercive treatment of anorexia is a contentious issue within contemporary bioethics yet remains understudied relative to other clinical populations . This dissertation examines the coercive treatment of anorexia and argues that it can be justified in some cases , using a combined nuanced-capacity and ethics of care approach . In defending this position , I consider the role of patient autonomy and illustrate that patients with anorexia often lack the capacity to make autonomous treatment decisions . Following this , I discuss concerns surrounding the potentially harmful nature of coercive treatment and the role of the clinician as a facilitator for harm . I resolve these concerns by demonstrating that , in cases where the benefits of employing coercive methods outweigh the harms incurred through doing so , coercive treatment can be regarded as an act of beneficence and long term nonmaleficence and can thereby be justified . I then highlight the significance of the therapeutic relationship and argue that coercive treatment should be implemented in the context of a caring and supportive therapeutic relationship that is guided by the ethics of care .
CHAPTER 1 : INTRODUCING ANOREXIA AND COERCION
1.1 . Explaining Anorexia
Anorexia is a mental health disorder that is characterised by a significantly low body weight , an irrational fear of gaining weight , and distorted cognitions surrounding body image , weight , and ‘ drive for thinness ’ ( Gorwood et al ., 2016 , p . 1 ). Here , a ‘ significantly low body weight ’ means below ‘ minimally normal ’ or what is expected in the context of age , sex , height , and ‘ developmental trajectory ’ ( American Psychiatric Association , 2013 , p . 338 ). In their diagnostic criteria of anorexia , the American Psychiatric Association ( 2013 , p . 338 ) also cite a ‘ restriction of energy intake relative to requirements ’, persistent behaviour that inhibits weight gain , and a failure to acknowledge the severity of one ’ s low body weight as primary characteristics of anorexia .
There are two forms of anorexia : ‘ restrictive ’ ( RA ) and ‘ binge-eating and purging ’ ( AN-BP ). Anorexia is categorised as RA when a patient ’ s weight loss is achieved primarily through the restriction of nutritional intake and excessive exercise ( American Psychiatric Association , 2013 , p . 338 ). In the AN-BP subtype of anorexia , individuals also engage in ‘ episodes of binge-eating or purging behaviour ’ such as self-induced vomiting and laxative abuse ( American Psychiatric Association , 2013 , p . 338 ). My discussion pertains to both subtypes of anorexia and , as such , any subsequent reference to anorexia is a reference
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