Some anorexic patients need ‘assisted dying’, says eating disorder specialist
A leading eating disorder expert has proposed that patients with anorexia nervosa should be allowed access to assisted suicide. Doctor Jennifer Gaudiania Denver-based physician, argues in the Eating Disorders Diary this:
“… patients with terminal AN [anorexia nervosa] who are severely compromised physiologically and whose suffering at the end of life results from both psychological and physical pain, should have access to medical assistance in dying in places where such assistance has been legalized, just like others terminally ill patients.“
Assisted suicide is legal in Colorado, where Dr. Gaudiani practices.
There is no doubt that anorexia nervosa (AN) is extremely dangerous. It has the second highest death rate of any psychiatric disorder after opioid use – the singer Karen Carpenter is probably his most famous victim. But normally it is treatable.
However, Dr. Gaudiani believes there are AN patients who suffer from an increased form of the disease, which she calls “severe and persistent anorexia nervosa” (SE-AN). These people are over 30 years old; all previous treatments failed to help them; and they are able to make the autonomous choice to stop prolonging their life.
In her article, she tells the stories of three of her patients who gave up fighting their disease and chose to die.
His stories are meant to be heartbreaking – and they are. One was even written by a posthumous co-author of the article. Dr. Gaudiani tries to demonstrate that the effort required to get them to eat properly was indeed a painful treatment. In his view, their psychiatric disorder was intractable. Therefore, SE-AN patients should have the option of medical assistance in dying or medical assistance in dying (MAID), as she prefers to call it.
The accounts, however, do not offer overwhelming evidence for this. In the first, Aaron, a 33-year-old man, refused to seek treatment. He didn’t even ask for a MAiD. Jessica, a 36-year-old woman, took a fatal prescription and died surrounded by her family. And co-author Alyssa, a 36-year-old woman who had battled AN for 15 years, was given a fatal prescription but died in hospice without actually taking it.
Dr. Gaudiani is advocating for colleagues to recognize that SE-AN exists and that assisted suicide is appropriate end-of-life care for patients who suffer from it.
However, his reasons are more emotional than logical. As the Australian psychiatrist John Buchanan observed MercatorNet, anorexia is a very complex disease. Medicines are only one piece of the puzzle. Those affected need psychotherapy and behavior modification therapy – and they can take years to be successful.
“The distress a person with a disease experiences is proportional to the quality and extent of treatment and care,” says Dr Buchanan. “There is a lot of poor quality psychiatric treatment being provided.”
Therapy may also be needed for families to help them resolve to support their loved one. This adds an extra layer of complexity to the processing. As Dr. Buchanan points out, “The psychological reality is that family members often have very ambivalent feelings about a seriously ill person. The idea that all families are benevolent and benevolent is sadly false. Many would prefer that the ill person ‘move on’. What if the anorectic patient fails to recover because their family simply does not commit to providing the necessary level of care? In such a case, recourse to MAID would lift the patient out of family poverty.
Dr. Gaudiani insists that physician-assisted suicide is not suicide: “MAID is offered to people whose death is inevitable within six months of an underlying disease process; it allows patients to choose how they die, not whether they die. It’s not a means of suicide.”
This, however, is pure sophistry. Choosing a place, a method and a time to end one’s life is suicide. Moreover, no doctor can predict with certainty how long a patient will live. Treating MAID as a natural end of life for people with anorexia is actually medical negligence. If doctors persevere with patients who suffer from cancer, heart disease or diabetes for years, why not with anorexia?
Bioethics writer Wesley J. Smith, written in the national journalrecently called this approach “abandonment”.
“So why not allow an intentional and fatal overdose of opioids as a “treatment” for an opioid use disorder? Once you open the door to one by redefining it as “terminal”, you will no longer be able to prevent others from entering. When psychiatrists abandon their mentally ill patients – and are in effect allowed to help them commit suicide – who will defend the value and continued importance of their lives? How will these very unfortunate people be kept among us during their darkest days?“
As Dr. Buchanan points out, allowing assisted suicide for anorexia nervosa would remove barriers to this option for other people with psychiatric illnesses.
“Mnone of them are suicidal at any point in their care. Most are salvageable and then thankful they didn’t act on their suicidal thoughts. It is absolutely simplistic and naive to act on the suicidal thoughts of people with psychiatric illness when they are obviously for the most part completely treatable. The most obvious are depressive illness, bipolar disorder, but many other conditions have an element of depression marked by suicidal thoughts! »
Anorexic patients can be very intelligent, but they are prey to the fantasy that they are overweight. The responsibility of their families and doctors is to support reality and not illusions.
International Helplines can be found at www.befrienders.org. In the United States, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for assistance. You can also text HOME to 741741 to get in touch with a crisis text line counsellor. In the UK and Ireland, Samaritans can be contacted on 116 123 or email [email protected] or [email protected] In Australia, the crisis support service safety rope is 13 11 14.