If you were to look online, I am sure you could discover a plethora of inspirational stories about dying anorexics who cheated death and freed themselves from their eating disorder. But for every patient who survives the horrors of this dangerous and sometimes fatal brain disorder, there is a story of a patient who has spent a majority of their life in and out of hospitals and treatment centers. These are the patients who, no matter what evidence-based therapy they receive or how much weight is restored, are chronically relapsing. And each time their eating disorder forces them to return to their starvation diets, their physical state continues to go further and further towards a point of no return. Their heart becomes weak, the functions of their vital organs begin to go haywire, and whatever life was in them slowly fades away. Realizing that their quality of life is greatly diminished and that the world of modern medicine cannot rescue them from their eating disorder, many chronic anorexics long to end their suffering by discontinuing treatment. Of course though, family members, friends, and medical staff have a hard time accepting this – actually many don’t accept it at all. They force the patient into treatment by getting court orders claiming the patient does not have the ability to make medical decisions. Though there are anorexic individuals who I believe are cognitively impaired due to their eating disorder and unable to make life and death decisions, I do believe this is not the case for all of the chronically anorexic population.
The majority of chronic anorexics have suffered considerably, both emotionally and physically, during the course of their illness. They realize that their prognosis is grim and it is quite apparent to everyone around them that the idea of them achieving a full recovery is nothing but a dream. Yet despite this realization, doctors and family members continue to insist that the patient receives futile medical care. We all know that with legal authorization that the anorexic can be force fed through a feeding tube, but many of these chronically ill patients sabotage this form of treatment by yanking out the tube or even secretly diluting the feeding tube formula. There is even scientific literature stating that if an anorexic completely refuses to cooperate, these invasive measures to stuff the patient with nutrition are likely to fail and even physical progress (ex: weight-gain, medical stabilization) that is achieved using these measures are short-lived.
In my opinion, there comes a point where doctors and members of the patient’s family must accept that curing the eating disorder is not a viable option anymore. It is not humane to make the patient continue to have such a poor quality of life because they are constantly in and out of hospitals and endlessly force-fed. When it becomes obvious that a patient is unresponsive to comprehensive, evidence-based treatment, I believe the patient has the right to palliative care and hospice. These two humane alternatives allow the patient to pass away comfortably and be able to end their seemingly endless struggle with their severe, treatment-refractory eating disorder.
Now I know many of you might disagree with me and before you start typing furious comments in response to this post, please consider this example. Let’s say their is a patient who is struggling with cancer. For years this patient has battled the disease and has received intense doses of chemotherapy, radiation, and has even enrolled in multiple clinical trials in hopes some experimental medicine would end his/her fight. Unfortunately, the cancer has metastasized and now curing the cancer is no longer a possibility. The doctor has suggested to put the patient on a chemotherapy regimen in order to keep the cancer at bay and prolong the patient’s life. After much deliberation, the patient has decided NOT to go on the chemotherapy regimen and instead receive palliative care until the time of his/her death comes.
I argue that a patient with chronic, treatment-refractory anorexia nervosa is no different than the patient with incurable cancer I described above. If an anorexic patient has suffered with their disease for so long and has been unable to respond to treatment at even the renowned hospitals and ED centers, the patient has the RIGHT to end to treatment and receive compassionate palliative care. PERIOD.