Ethical Issues in the Treatment of Eating Disorders

Ethics is an integral, essential part of good clinical practice, and the ethics of treatment of eating disorders is particularly difficult for many clinicians. In this chapter, we draw on the cultural safety literature to consider the complex ethical issues of eating disorders treatment from a different perspective. This will help clinicians as individuals and teams to acknowledge, discuss, and challenge their own assumptions, values, beliefs, and power. Further, we advocate that clinicians engage in learning from patients and their loved ones about what recovery and rights-based approaches to treatment and support might look like for them. Seeking to understand the patient’s experience, values, and priorities goes some way to addressing the power imbalances inherent to professional work and enables collaborative decision-making that is sensitive to context. We provide an ethical framework in the form of a series of questions which can be used by clinicians with patients and families to facilitate discussion and help inform treatment decisions. We consider issues such as compulsory treatment, capacity, severe and enduring eating disorder, palliative care, treatment futility, and end of life care in the context of this framework. We also consider how teams may be able to reflect and have honest, interdisciplinary discussion about these difficult areas when it may be difficult to voice individual views because of hierarchy/power dynamics within the team.