Legal & Ethical Issues

Management of child and adult with anorexia nervosa is often complex because the wishes of patient is often in conflict with the goals of treatment.

Principles of Good Practice
Doctors should explain to parents about
· What an eating disorder is, with specific reference to characteristics of particular disorder
· What is entailed in treatment, both in terms of physical management
Care should be given to elicit patient’s perception of her illness (understanding, feelings what it entails in terms of a specific eating disorder)

Ethical Issue
In the case of anorexia nervosa patient’s sense of control is derived from their regulation of food and caloric intake. They somewhat feel that their personal autonomy is violated when this regulation encounters disruption by doctors and parents who assume responsibility of their diet. Most of these patients become increasingly chaotic and frustrated due to the loss of power over their lifestyle choices.

Refusal of Treatment
When adult decline treatment (UK)
1. Clinicians can make an application under the Mental Health Act 1983 for the patient to be compulsory admitted to an appropriate unit or hospital for treatment.
2. Opinion of 2 independent psychiatrist are required to establish a diagnosis and give opinion as to whether or not treatment is necessary
3. Social worker will conduct assessment to determine whether or not it is in the patient’s interest for hospital admission to proceed.
4. Patient’s right will be upheld at tribunal system which allows which allow regular review of her status and gives her the right to appeal against treatment with appropriate reasoning.

Euthanasia (from self suffering)
Clinician should respect patient’s right of self determination. On the other hand, starvation could impair their cognitive functioning which may compromise her decisions. Depressive effects are most often followed by suicidal acts. Since anorexia is a treatable condition, it further adds pressure on clinician to intervene. It seems therefore unethical to withhold treatment on the basis of difficulty in engaging their co-operation.

Legal aspect
If a child below 16 refuses to eat or actively avoids treatment, treatment can be still given if parents consent on her behalf.
If patient is over 16, guidance will be sought from court so that she can express her views through legal representatives independent of her parents.
The right of a child to under the age of 18 to consent or withhold consent to treatment is dependent in the UK on whether or not the child is deemed Gillick- competent. The principles highlights a child’s right to self determination i.e her right to decide what happens to her own body. The child must have sufficient understanding to appreciate the nature of what treatment is involved and the implications of it.

Reference
Ethical and legal issues by Marianne Bentovim London child and family consulatation service