Force Feeding Patients With Anorexia Nervosa

Patients, doctors, family, and even the courts all bring a different perspective to this issue, making it extremely complex.

Clinicians know the benefits feeding provide and research does support this, e.g. Serfaty and McCluskey's work. However this did have low population validity due to the small number of patients, restricting the application of its findings to larger populations. Research in this area is limited to retrospective data, as withholding potentially life-saving treatment randomly in controlled trials would be unethical. The patient on the other hand, due to psychology of their condition, cannot even contemplate eating as an option. To them, and possibly their family, it is not worth the emotional suffering that feeding will bring. The erroneous thinking traits discovered in anorexic patients I believe are crucial to this argument. These distortions inhibit their ability to rationally make decisions and appreciate both the costs and benefits. It is for this reason I believe that although deemed competent, these patients do not have the capacity to decide their own medical treatment.

The risks of causing re-feeding syndrome, and subsequently delirium, I do not believe are majorly important. This is because doctors would only suggest force-feeding, at the point where the risks associated with these comorbidities are lower than that caused by their weight.

Although I believe anorexic patients do not have the capacity to decide their own treatment, this does not mean I think they should be always force-fed. After looking into personal reasons for their treatment refusal, such as attempting to avoid adulthood, I do not think it is always worth the distress it would cause the patient.

In my opinion, patients should be forcefully fed when there is a realistic potential to significantly improve their life; meaning factors affecting prognosis e.g. age at onset duration of illness need to be considered. I believe the decision should lie with doctors, as to whether the potential benefits of treatment outweigh the emotional stress the patient will experience.