Is Force Feeding Anorexics Legal
Some time ago, I was listening to LBC radio. The object was a decision in favor of what is known as force-feeding of patient E. On Saturday, Norman Lamont suggested that the decision to be force-fed could be an interference with their right to self-determination. To make matters worse, the parents of the young medical student – anorexic for eleven years – want their daughter to die with dignity. Our findings include several important implications for physical restraint use and management during hospital treatment in AN adolescents. First, interventions given pervasively to all patients to reduce the likelihood of physical restraint may not be very effective in reducing the total number because the majority of patients experience little or no physical restraint. Additional examinations of people with frequent episodes of physical restraint may lead to a better understanding of how to reduce or eliminate reluctance in this group. Secondly, and in line with the objective of health authorities to reduce the use of involuntary treatment and coercive measures in psychiatric wards, treatment units should strive to provide voluntary treatment as much as possible. However, reduction in episodes of servitude could be achieved through selective targeting, with treatment units achieving significant reductions in servitude episodes through subtle changes in admission policies, transfer of selected patients to another ward, or early discharge, which would not be a clear benefit to affected patients . For this reason, further studies of physical restraint in emergency treatment should ideally include multiple sites and also consider the extent of physical restraint in non-psychiatric settings, particularly in somatic units. Finally, countertransference responses appear to be important for understanding clinician-patient dynamics in adolescent AN . Staff emotional reactions also appear relevant to understanding the escalation and persistence of patient aggression , which may be relevant to compression rates.
In our view, the contribution of clinicians` emotional responses and behaviours to the emergence of coercion in treatment settings in general, and in particular to the escalation of NGT force-feeding episodes, merits further investigation. The higher number of physical bondage episodes during the day shift and no bondage episodes during the night shift was due to the unit`s method of not administering NGT feeding at night. Furthermore, during the data collection process, it became clear that while the immediate behaviour prevented by physical restraint was generally coded as self-harm, the behaviour was often preceded by events related to food or meals in the unit (e.g., receiving the message that calories would be increased or finishing a meal). To the extent that food anxiety [27, 28] is a common denominator, the relative absence of triggering events related to food or meals at night would be relevant to explain the observed temporal pattern. One qualitative study specifically examined the experiences of caregivers and patients who had previously received nasogastric tube feeding (NGT) during treatment of erectile dysfunction in adolescents, where more than half of patients were retained due to resistance to the procedure . In short, it was found that NGT had been experienced negatively at the time, but was perceived as useful in retrospect. The majority of participants did not believe that there were viable alternatives to NGT feeding. Neither physical resistance nor adverse effects reported to treatment had a clear association with the outcome. There may be causes of eating disorders, and this should be investigated. Trying to control what the person eats, how much they eat and when can be triggering rather than beneficial.
I am sure that every survivor of abuse will identify an abusive nurture as an enemy and treatment as a struggle for control. Do not punish the patient, otherwise, as this author points out, he will return immediately as soon as he is free. Not so long ago, I would have been heavily on the side of force-feeding, but now I`m not so sure. I think force-feeding is and will remain a life-saving tool for many people with eating disorders, but when used alone on a long-term patient in a non-eating disorder unit, I have begun to question its usefulness. Number of episodes of physical bondage in the unit, ranked according to the patient`s legal status and justification Although it does not refer to the transgender debate, a recent article in the journal Bioethics by a University of Hong Kong lawyer, Eric Ip, argues for forcing anorexic patients to accept treatment. Patients with anorexia often make living wills stating that they should not be force-fed if their condition worsens. However, Ip asserts that “patients with anorexia nervosa have, at best, compromised autonomy and, at worst, no autonomy at all to make meaningful living wills on life or death scenarios.” He continues: “In a situation where you are looking for life-saving interventions in the form of force-feeding, legal and judicial interventions may be necessary, and these should be pursued if you deem it absolutely necessary. Many health professionals may think that the risk of refeeding syndrome in cases of extreme malnutrition can itself be fatal. There is much debate between short-term mortality, which can be avoided with tube feeding or force-feeding interventions, and long-term recovery prognosis. Studies on the use and effects of physical restraint in the treatment of anorexia nervosa (AN) are lacking.
The aim of this study was to describe the frequency of physical restraint in a specialised programme for adolescents with AN and to examine whether meal-related physical restraint (forced nasogastric tube feeding) was related to the outcome at 5 years. Involuntary treatment of eating disorders (ED) is used as a last resort in cases where there is a significant risk to the patient, which cannot be treated in a less restrictive manner [1-3]. Restoring a normal body weight, which depends on feeding meals several times a day, is a cornerstone of particularly difficult treatment . To our knowledge, no quantitative study has examined the extent to which weight recovery is facilitated by the use of physical restraint, i.e. the use of physical force to restrain or control the patient. In the literature, the general view is that interventions with physical restraint do not have inherent therapeutic effects in the treatment of children and adolescents  and may be associated with negative psychological outcomes [6, 7]. However, the literature has largely focused on physical restraint to manage patient aggression [8, 9], and therefore cannot be generalized to physical restraint used to administer nutrition in emergency departments. A person with anorexia nervosa may need to be force-fed if they refuse other types of treatment or refuse to eat whole. Some people perceive force-feeding in hospital as traumatic and a violation of a person`s rights.
However, a person with anorexia suffers not only physically, but also psychologically, and additional psychiatric care is essential to save the person`s life. This study describes the frequency of physical restraint in a special program for adolescents with anorexia nervosa and examines whether the use of physical restraint is related to the outcome at age 5. About two-thirds of patients did not experience episodes of restraint, either to provide tube feeding or to prevent damage. However, a small number of patients experienced a large number of bondage episodes, i.e. four of the 38 participants (11%) accounted for 91% of all physical bondage episodes. Therefore, it is important to know more about patients with many boutage episodes in order to avoid escalation of resistance to treatment and subsequent use of restraint. Patients who experienced episodes of enteral feeding contention had a higher rate of persistent eating disorders at 5 years follow-up compared to patients without compression episodes. People who are hungry and self-injurious are unable to make the best decisions for themselves. A person with anorexia does not have the ability to see what is in their best interest, nor to make informed and healthy choices. Force-feeding is a decision made after careful consideration, because the benefits outweigh the risks and it is better than letting individuals continue to use harmful habits and behaviors.
The use of physical restraint in the treatment of ammonium nitrate poses complex ethical dilemmas for health authorities, institutions and staff performing the restraint. Physical stress can also be extremely resource-intensive and demanding, both financially and in terms of staff expertise. We found that each episode of restraint involved a large number of employees (mean 3.5, SD = 1.2) for a significant period of time (mean 22.9 min, SD = 16.9).