Let’s do a quick recap on some of the core stats around Anorexia. Up to 4% of women and 1% of men are likely to develop Anorexia at some point in their lives. About 50% of people will fully recover, and approximately 30% of the others will mostly recover. The average recovery period is about seven years for women and three years for men. For the remaining 20%, they will go on to have long-term problems, and it is a subset of this group that this palliative care is being suggested.
An argument for palliative care is that if someone has any chronic medical condition that they can’t recover from and it causes them extreme and debilitating pain, constantly intervening to prolong a painful, poor quality of life can be argued to be less moral than helping them die with dignity and less pain. Even though it seems horrible, you can see where these clinicians are coming from when you realise they want to reduce someone’s suffering in the long term.
An argument against this is that mental health conditions, almost by definition, distort perceptions. How can anyone then make a rational decision to end their life? Accepting someone with anorexia can make the decision to end their life seems to be very similar to accepting that someone with chronic depression should be assisted in ending their life. If we think about this parallel with suicidal depression, we can see more clearly why it can’t be right to help someone end their life; we must, instead, help them make life less painful and redouble our efforts to find better treatments.
For the most unwell clients, there isn’t much evidence that forcing them to accept treatments is very effective, even in just saving their lives, so we could and should do a lot more to make treatment less coercive and unpleasant and instead make it as inviting, interesting, kind and gentle as possible. That may sound like it’s stating the obvious; however, there are still some very unpleasant treatment facilities and methods being used, and an unnecessary extra level of pain is being added to an already desperate situation.
I’ve seen this topic come up in conferences and be discussed in the press quite a few times this year, so it’s worth reviewing the discussions and seeing where people are coming from, as it’s likely to keep coming up.
At the London Eating Disorder conference earlier in the year, Professor Hubert Lacey mentioned his consideration of Palliative care as an option for chronic and enduring anorexia.
Professor Lacey also Edited the book Managing Severe and Enduring Anorexia Nervosa, which has a chapter by Allan S. Kaplan and Amy Miles titled:
The Role of Palliative Care in Severe and Enduring Anorexia Nervosa.
At the end of last year, Jennifer Gaudiani, M.D., and colleagues published in the Journal of Eating Disorders proposing criteria for the term “terminal anorexia.” This new classification would make it easier to access medical assistance in dying ( MAID ).
In response to leaked NHS documents suggesting that the NHS was considering palliative care for severe enduring anorexia nervosa, the Royal College of Psychiatry published a statement saying they didn’t consider this an appropriate pathway.
Palliative care for Anorexia was also the subject of BBC Radio 4’s Inside the Ethics Committee.
Forced treatment is *not* evidenced to improve outcome: