challenging . This is primarily due to the difficulty associated with distinguishing coercion from excessive social influence ( Matusek and O ’ Dougherty , 2010 , p . 435 ). Here , ‘ coercion ’ is defined as the use of force , influence , or persuasion to obtain compliance . Coercion can occur both formally , through formal legal compulsion , and informally through the ‘ influence , pressure or manipulation ’ of a patient ’ s decisions ( Chieze et al ., 2021 , p . 2 ). In the context of psychiatry , coercive methods are defined as treatment methods that are applied against a patient ’ s will or despite their opposition ( Chieze et al ., 2021 , p . 2 ).
CHAPTER 3 : ETHICAL CONCERNS IN THE COERCIVE TREATMENT OF ANOREXIA : AUTONOMY AND CAPACITY TO CONSENT TO TREATMENT
Several ethical concerns arise in the coercive treatment of anorexia . In this chapter I will discuss ethical concerns surrounding patient autonomy and a patient ’ s capacity to consent to treatment . I aim to resolve these concerns by illustrating that patients with anorexia often lack the capacity to make autonomous decisions regarding their treatment .
3.1 . Autonomy and Coercive Treatment
‘ Autonomy ’ can be defined as the personal exercise of self-governance or , in more simplistic terms , the freedom to act in accordance with one ’ s own values and desires ( Matusek and O ’ Dougherty , 2010 , p . 436 ). In a medical setting , the principle of autonomy confers the right to elect or refuse proposed treatment strategies ( Sjöstrand and Helgesson , 2008 , p . 113 ). This means that medical practitioners cannot impose treatment upon patients without their consent , except in cases where a patient lacks the capacity to make autonomous decisions regarding their treatment ( Sjöstrand and Helgesson , 2008 , p . 113 ). Maintaining a respect for patient autonomy is a central tenet of the Western medical profession that ensures that a patient has ‘ jurisdiction over his or her own body and what is done to it ’ ( Silber , 2011 , p . 285 ).
Many critics use the principle of autonomy to argue against the coercive treatment of anorexia ( see Draper , 2003 and Rathner , 1998 ). According to such critics , patients with anorexia should never be treated against their will ( coercively ) as doing so would encroach upon their autonomy and fundamental rights to freedom of movement , freedom of will , and bodily integrity ( Chieze et al ., 2021 , p . 2 ). Proponents of this view hold that in discussions of coercive treatment , autonomy ‘ trumps all other considerations ’ ( Silber , 2011 , p . 285 ). I agree that maintaining a respect for patient autonomy should be central to the treatment of anorexia . I also grant that some patients with anorexia do have the right to refuse treatment , even if this refusal seems unwise to clinicians and other third parties ( Draper , 2000 , p . 126 ). However , it is important to emphasise that this right is contingent upon whether a patient possesses the autonomy to make treatment decisions ( Matusek and O ’ Dougherty , 2010 , p . 436 ). In what follows , I will argue that patients with anorexia often lack the autonomy to make treatment decisions .
3.2 . Determining Autonomy in Patients with Anorexia
In accordance with the account of Beauchamp and Childress ( 2001 , p . 58 ), a decision can only be regarded as autonomous if it is made deliberately and without the influence of external control . This account also posits that , for a decision to be autonomous , it must be
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