Ethical re-evaluation of contemporary treatments for anorexia nervosa: Is an aspirational stance possible in practice?

Does section 63 of the Mental Health Act 1983 disempower patients with mental illness? Analysis of the case law

In England and Wales, detained psychiatric inpatients are treated under section 63 of the Mental Health Act 1983. This paper critically analyses the relevant law and considers the arbitrary distinctions between consent for treatments for mental illnesses and physical conditions, which may disempower patients with mental illness. Section 63 states that (for detained psychiatric patients) consent for medical treatment for patients' mental disorder is not required. The treating clinician responsible for a patient decides what this medical treatment entails. This article focuses on three main legal cases: B v Croydon Health Authority, Tameside and Glossop v CH and Nottinghamshire Healthcare NHS Trust v RC and considers whether s 63 disempowers patients with mental illnesses.

Treating Eating Disorders at Higher Levels of Care: Overview and Challenges

Higher levels of care (HLC)-including inpatient hospitalization, residential treatment, partial hospitalization, and intensive outpatient treatment-are frequently utilized within routine care for eating disorders. Despite widespread use, there is limited research evaluating the efficacy of HLC, as well as clinical issues related to care in these settings. This review describes the different levels of care for eating disorders and briefly reviews the most up-to-date guidelines and research regarding how to choose a level of care. In addition, as HLC approaches for ED continue to be developed and refined, pragmatic and conceptual challenges have emerged that provide barriers to clinical efficacy and the execution of high-quality treatment research. This review includes a discussion of various issues specific to HLC, as well as a summary of recent literature addressing them.

Forced treatment of anorexic patients: part 2

PURPOSE OF REVIEW

The purpose of this review was to update and complement part 1 of this study. Clinical, ethical and legal approaches to forced treatment in patients with anorexia nervosa were considered in the light of recent literature.

RECENT FINDINGS

The first comparison of compulsorily detained adolescents and those treated under parental consent shows mainly advantages in the short and medium term of using the Mental Health Act. In a qualitative study, a pathway for advance decisions has been developed. Implications of the Human Rights Act for clinical practice have been elucidated. A case report of a pregnant anorexic woman shows the risk for her foetus. The ethical dilemma of treating a woman with cerebral palsy and chronic anorexia nervosa has been reported and an ethical re-evaluation of treatments for (especially chronic) anorexia nervosa recommended.

SUMMARY

The treatment of adolescents with severe anorexia nervosa may be improved by detention under the Mental Health Act. The Human Rights Act has implications for the treatment of anorexia nervosa. Guidelines for treating anorexia nervosa should include recommendations for pregnant sufferers as well as for those with severe physical comorbidity. A shift from cure to care for chronic anorexia nervosa might improve ethical conduct.