Debate: Should Anorexic Patients Be Force-Fed in Treatment?

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A recent court case raised serious debate worldwide on whether or not it is okay to force feed a patient with anorexia. Now, the question remains: Is it right to force-feed a patient with severe anorexia against their wishes? Dr. Evan Harris, the former Liberal Democrat MP and a member of the British Medical Association’s ethics committee, responded stating that the decision to force-feed an anorexic patient was a serious one:

“The implications of force-feeding are really significant because she would need restraining or sedation and the treatment would last a year… It might not succeed and is itself life-threatening. To impose that on a patient who might be competent in refusing treatment is a very major step.”

The 32-year old woman was described as not having consumed solid foods for a year. Her parents were reported to have told the court: “It upsets us greatly to advocate for our daughter’s right to die… We feel she has suffered enough…”

It is estimated that the woman stood only a 20% chance of recovery even if she was put on an invasive force-feeding program that would last a year.  Force-feeding can even be as dangerous for an eating disorder patient as starving to death. In that case, force-feeding does not guarantee recovery. Should it be a treatment option for anorexia?

 Let’s look at the arguments for and against these types of treatments:

Arguments in favor of force-feeding:

1. Force-feeding is a necessary treatment:

   It is done because the patients are not able to form independent and rational judgments regarding the consequences of their decision. Therefore, this argument believes it is the responsibility of the doctor to keep the patient alive to make way for treatment.

2. Force-feeding is needed to treat the psychological problems of the patient:

   Several studies note that starvation affects the functioning of the brain. Therefore, force-feeding is the only way to treat the illnesses suffered by anorexia patients due to starvation. Through treating the starvation, it helps progress treatment for the anorexia patient. Saving a life is more important than the dignity of the patient, the argument notes.

3. Providing palliative care is an insufficient alternative:
   

   Palliative care, or care focused on providing comfort during life-threatening illness, is argued as defeatist. The argument is that this type of care does not cure the real problem. Better support structures are needed so doctors can proper treat patients.

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Arguments against force-feeding:

1. Force feeding is considered as undignified:

   Force-feeding is argued to be a degrading treatment and in many countries, is prohibited. Patients should have the right to refuse this type of treatment, even if the patient is considered mentally ill, this argument notes. Furthermore, anorexia is not officially recognized as a mental illness worldwide, therefore mental illness is not a valid reason to force-feed.

2. It is a temporary solution:
   

   The other main argument is that force-feeding is only a temporary solution, and does nothing to alleviate the fear patients have about gaining weight. Therefore, compulsory treatment may only act as a barrier to Over 27 percent of anorexia deaths are caused by suicide. This type of force-feeding treatment could make patients more depressed and increase the risk of harms. Furthermore, patients may fear seeking treatment at a hospital because they fear being force-fed. The risk of force-feedings could result in more patients avoiding treatment altogether.

3. Palliative care is preferred due to low recovery rate:
   

   Palliative is argued as a better alternative to force-feeding because the recovery rate among sufferers of anorexia is very low. Research has shown that during the last 10 years, only 20 percent of anorexia patients made full recovery.

Anorexia Nervosa is a serious disorder in which treatment must be tailored to the individual. In some cases, lifesaving interventions may be required; however, the debate is whether these interventions are okay.  There has been a rise in a number of patients admitted to treatment, but this could be due to more people seeking treatment. It is difficult to know what the best treatment approach there is to anorexia patients.

What are your thoughts on force-feeding? Should it be a viable treatment option? If you or anyone you know is struggling with substance use disorder or mental illness, please call toll-free 1-800-777-9588.

Author: Shernide Delva