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

"Unlike patients with other mental health disorders, such as schizophrenia or bipolar illness, for whom a medical physician rarely needs to be involved in care delivery, patients with eating disorders have a litany of significant medical complications that demand close oversight by a medical doctor knowledgeable in treating these disorders. However, prior to the 1980s, little available literature elucidated the best medical practices for these patients, and currently, very few physicians have much medical expertise in this specialized area. This is disconcerting, because these patients are known to be frequent utilizers of the medical system who are often admitted to hospitals and emergency departments for medical complications of their disorders. In addition, anorexia nervosa has the highest mortality rate of any mental disorder except opioid abuse, and the standardized mortality ratio for bulimia nervosa is almost twice that seen in age-matched control subjects. Moreover, much of the excessive mortality rate in AN is attributable to medical complications. Thus, there is an impelling need for this book, which highlights the medicolegal and ethical challenges in treating individuals with EDs. Progress in the medical and psychological treatment of eating disorders over the past half-century has shown us what we can do but sometimes leaves unanswered questions about what we should do in difficult situations, such as the case of a person with a severe and enduring eating disorder who is symptomatic, resists treatment, and requires repeated involuntary hospitalizations. This book explores the ethical and legal dimensions of these difficult questions"--
From the Inside Flap
Treatment advances, both medical and psychological, have increased what can be done for patients with severe eating disorders, but answers to what should be done remain elusive. For this reason, Tipping the Scales: Ethical and Legal Dilemmas in Managing Severe Eating Disorders is a groundbreaking book, one that takes an unflinching look at the role of ethics in compelling treatment for individuals with severe and enduring eating disorders (SEEDs) and the legal context in which coercion, civil commitment, and related issues are situated. Although eating disorders have commanded a great deal of attention from the media, prior to the 1980s there was little published literature to elucidate best medical practices for patients with SEEDs, and currently very few physicians have much medical expertise in this specialized area. The editor, an expert in both eating disorders and forensic psychiatry, has convened a group of contributors who are similarly accomplished, and together, they explore ethical considerations, coercion in treatment, mental capacity in anorexia nervosa, medical guardianship, civil commitment, harm reduction, palliative care, end-stage anorexia, physician-assisted death, and more.
These topics are complex, but essential, to consider, and the authors offer multiple case vignettes to help clinicians tease out the ethical issues and identify a clear path to care that is in patients' best interests. Tipping the Scales is unique in its fearless yet compassionate approach to managing the most treatment-resistant cases of eating disorders.
From the Back Cover
Treatment advances, both medical and psychological, have increased what can be done for patients with severe eating disorders, but answers to what should be done remain elusive. For this reason, Tipping the Scales: Ethical and Legal Dilemmas in Managing Severe Eating Disorders is a groundbreaking book, one that takes an unflinching look at the role of ethics in compelling treatment for individuals with severe and enduring eating disorders (SEEDs) and the legal context in which coercion, civil commitment, and related issues are situated. Although eating disorders have commanded a great deal of attention from the media, prior to the 1980s there was little published literatu