Anorexia and Autonomy (part 2)

In researching to write my previous post on this topic, for all my reading around on science journals and NHS factsheets, I missed the most important article I’ve read on the topic yet. Ilona Burton’s honest, elegant and profoundly thought-provoking account of her own experiences in the Independent, “force-feeding: there was a time when I would rather die than eat the food in front of me” is much more worthy of a read than the cumulative scholarly articles I came across.

My previous hang-up was over whether we can truly, fairly say that the woman in the current case can be deemed to be incapacitated by some combination of her physical and mental condition to the extent that she lacks legal autonomy. I say this tentatively as I’d hate to put words in her mouth, but Burton seems more concerned with a different question, one which I hadn’t fully considered;

Since 1997, doctors have had the power to force-feed anorexic people in order to prevent them starving themselves to death. It’s a desperate situation, but when a person is so entrenched in an illness that constantly tells you that food (and sometimes drink) is the enemy, you become paralysed with fear and will do anything, no matter how out of character, to avoid it. Many of the nursing staff I have spoken to about this have told me that they have struggled more when trying to restrain a frail, skeletal anorexic person than a fully grown burly male.

The argument for force-feeding is that the person in that position is not capable of making that decision for themselves, and so (lawfully) it is in their best interests. I would worry how many more deaths we would have from anorexia if it was not allowed.

But should ‘E’ be forced to continue a life (if you can call it that) that she no longer wants to live?

The question it comes down to really is over whether treatment is futile when a person is so far down that line of self-destruction.

I still haven’t properly considered the possibility of futility of treatment because I have no ability or qualification to do so, but it adds an extra dimension of confusion to an already baffling case. The available academic work I’ve come across, some of which is cited in my previous post, seems to suggest that they think there is always hope, but I was certainly struck by the extremity of this case relative to the ones they were often commenting on.

Moving on, Burton says;

I have never been as ill for as long as ‘E’, and even if I had, I would have no place to say whether this decision is right or wrong – nor do any of us.

and I think, in agreement, that’s where I’ll leave off commenting on the issue. I have never had to face anything like the struggles that ‘E’ has. I have no answers. What reflecting on this has left me with, however, is an increased sense of my gratitude for being fortunate enough to not have to face a daily trial like that. With thought to ‘E’, I’d readily echo Burton’s conclusion;

My fingers are crossed.


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About Jon Robinson

Lefty ex-politics student turned med student, interested in current affairs, economics, gender politics and health issues. Occasionally pretends to understand philosophy. @jon__robinson

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