Tipping the Scales: Navigating Ethical and Legal Dilemmas in Managing Severe Eating Disorders

Authored by Patricia Westmoreland, this book delves into the complex medicolegal and ethical challenges faced by healthcare professionals when treating patients with severe and enduring eating disorders (SEEDs). Unlike other mental health disorders, eating disorders pose significant medical complications that demand meticulous oversight by a physician knowledgeable in treating these disorders.

The alarming scarcity of such expertise is further heightened by the fact that anorexia nervosa has the highest mortality rate of any mental disorder, aside from opioid abuse. As such, this book explores the medical consequences of SEEDs, focusing on the subgroup of patients whose illness appears intractable, and who may no longer be seeking a “cure” but rather sufficient improvement to afford a reasonable quality of life.

The Delicate Balance Between Saving Lives and Reducing Suffering

In empathic and accessible prose, the book examines the ethical conflicts that arise in SEEDs, particularly the critical dilemma between saving a life and reducing suffering. While both are core values of medicine, relief of suffering through refeeding and other treatments can bring about both physical and emotional discomfort.

Patient Autonomy and Mental Capacity: Establishing Treatment Goals

The book reviews the issues of patient autonomy and mental capacity in determining treatment goals, as well as the assignment and role of medical guardianship for patients deemed incapacitated. This critical exploration sheds light on the complexities involved in making decisions that are in the patient’s best interests.

The Perception of Futility: Burnout or Hopelessness?

The book delves into the perception of “futility,” which may reflect burnout of the treatment team rather than no hope of success. This phenomenon may contribute to the increased emergence of physician-assisted death and euthanasia in this population, both internationally and in the United States.

Palliative Care, Harm Reduction, and Futility: Understanding the Differences

Dedicated chapters provide insight into the distinctions between palliative care, harm reduction, and futility, highlighting the critical role of psychiatry in cases where patients request palliative care. The book also addresses advance care planning and other essential topics.

Medical Complexities and Comorbidities: The Hidden Dangers of SEEDs

The book describes the intricate medical complexities and comorbidities inherent in caring for patients with SEEDs, including bone density loss, gastrointestinal complaints, and cardiac irregularities, which can result in death. Numerous case studies are presented for comparison, elucidating the thorny ethical and legal issues attendant upon caring for these patients.

Ultimately, Tipping the Scales assists physicians, mental health professionals, and patients in making informed decisions that prioritize the patient’s well-being, whether they lead to healing and recovery or a dignified passage within the bounds of our current knowledge and the ethics of palliative end-of-life care.