Chapter

Treatment refusal in anorexia nervosa: a challenge to current concepts of capacity

Jacinta Tan and Tony Hope

in Empirical Ethics in Psychiatry

Published on behalf of Oxford University Press

Published in print February 2008 | ISBN: 9780199297368
Published online February 2013 | e-ISBN: 9780191754586 | DOI: http://dx.doi.org/10.1093/med/9780199297368.003.0013

Series: International Perspectives in Philosophy & Psychiatry

Treatment refusal in anorexia nervosa: a challenge to current concepts of capacity

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The research study that we will describe in this chapter is an empirical exploration of ethical issues around treatment refusal in anorexia nervosa. Our view, like other authors who have contributed to this book, is that the investigation of issues in practical ethics often requires a combination of empirical and conceptual research.

Previous discussion of ethical issues in anorexia nervosa has largely been conducted either from theoretical perspectives, for example by medical ethicists, philosophers, and feminists, who have focused on the underlying principles and wider cultural influences (e.g. Gilligan 1982; Lee 1993; Russell 1995; Draper 2000; Gremillion 2003), or from clinical perspectives by professionals treating patients with an eating disorder who have explored the issues based on clinical impressions and frameworks (Gothelf et al. 1995; Beumont and Vandereycken 1998). There have been several systematic empirical studies in anorexia nervosa but these have focused almost exclusively on the nature of the disorder, its underlying psychopathological mechanisms, and developing treatment approaches (Gowers and Bryant-Waugh 2004). Some of this work has explored the accounts of experiences of patients and health professionals (Shisslak et al. 1989; Gremillion 2003; Colton and Pistrang 2004). A major reason for an interest in patient perspectives is the poor outcomes using traditional treatments based on an assumption that patients are motivated to overcome their problems. New treatment approaches are being developed, such as ‘motivational interviewing’, where the goal is to shift the patient along the ‘cycle of change’ towards the stage of seeking active change (Prochaska and DiClemente 1983; Miller and Rollnick 1991; Treasure and Ward 1997; Vitousek et al. 1998). Another area of research is examining the effectiveness of the use of compulsion (Ramsay et al. 1999). There has also been empirical work, much of it conducted from a feminist perspective, aimed at a critique of the psychiatric system and its treatment of women in particular (Russell, 1995; Gremillion 2003). Further empirical work looks at the relationship of women to their bodies (e.g. Orbach 1978; Bettle et al. 1998; Andrist 2003).

Despite this wealth of research and discussion there have been no previous systematic empirical studies of ethical issues that arise in the care of people with anorexia nervosa. In this chapter, we will describe a ‘preliminary study’ that was conceived as a pilot for such a systematic empirical study. We will discuss the rationale for the study, its methodology, and give a brief account of some of the results, using these to illustrate the relationships between empirical data and ethical analysis. At the time of writing this we have some results from the much larger subsequent study involving 29 participants. We will call this the ‘cross-sectional study’.

Chapter.  9559 words.  Illustrated.

Subjects: Psychiatry

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