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Should Anorexics be force fed?

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Background: Anorexia Nervosa has been defined as a self-inflicted starvation due to which the body weight of an individual becomes less than 15 percent of what is expected from the individuals of same sex and height. In UK as well as in several other western countries it has been classified has a mental illness. Anorexia is particularly associated with body image and woman as only one out of ten sufferers is male. The unrealistic portrayal of the female body by the media makes it worse and the mortality rate is between 5 to 18 percent. Anorexia has been found in patients from the age of 6 to 76 years and is found more commonly in the developed countries where it affects 1 percent of the female adolescents. The patients of anorexia become dangerously thin and some time they are force fed using a naso-gastric tube (through the nose). Under normal circumstances medical treatment is not administer without obtaining the consent of the patient but in case of patients who are mentally ill, the distorted perception of reality can render than unable in making a choice. However issues like medical ethics and human rights raised serious questions regarding such treatment.

Arguments in favour of:
1. Force feeding of anorexics is legal and treatment is provided to them under the mental health legislation. It is done so because the patients are not able to form an independent and rational judgment regarding the consequences of their decision. Furthermore it is also the responsibility of a doctor to keep the patient alive so that treatment can be administered.

2. Force feeding for anorexics is also necessary for treating the psychological problems of the patients. Studies worldwide have shown that starvation has an adverse impact on the functioning of brain therefore force feeding is the only way to treat the illness suffered by anorexia patients. Saving a life is more important than the dignity of such person. However unpleasant of painful a medical treatment may be, it is necessary for preserving life. The psychological problems of the patients can only be treated if the person stays alive.

3. Providing palliative care to the anorexics is an insufficient alternative. It is considered that palliative care is defeatist is nature and a does not try to cure the real problem. Only because the schedule of the treatment is very long which can be harrowing for a doctor, Itcannot be a reason to opt for palliative care. Better support structures need to be introduced so that the doctors can full fill their obligations towards the patients.

Arguments Against:
1. Force feeding is considered as undignified and therefore it is also illegal. Degrading treatment as defined in Article 3 of the European Convention on Human Rights has been prohibited. The patients have a right to refuse treatment and this right needs to be respected even if the patience is mentally ill. However it also needs to be noted that anorexia has not been recognized as a mental illness in the countries of the world.

2. It can be argued that compulsory treatment can be successful only for a short period and such treatment does nothing to alleviate the fear of the patients regarding food weight and hospital. Therefore such compulsory treatment can even act as a barrier in the treatment. More over 27 per cent anorexic deaths are caused by suicide and the compulsory treatment can make the patients more depressed and therefore increased the chances of harm. The fear of weight gain, especially the weight gained by force feeding can act as an obstacle in the treatment of anorexics. If the patients believe that they may be force fed at the hospital, they are less likely to seek advised or treatment. Force feeding can also pose a risk to the health of the patients as the anorexics patients are extremely thin and force feeding can lead to Hypophosphataemia (reduction) of phosphates in the blood) which in turn causes heart failure. The risk of force feeding can also result in the avoidance of the treatment by the anorexic. As they are characterized by self-denial they do not generally come forward for treatment voluntarily and the chances of doing so can become ever lesser if they have an apprehension of force feeding.

3. Palliative care has been advocated by some doctors because the full recovery rate is very low among the sufferers of anorexia. Research has shown that during the last 10 years only 20 percent of patients of anorexia were able to make a full recovery and in case of the patients who have been suffering from anorexia for the last 12 years or more, the chances of making a full recovery were almost negligible.

This article has been written by KJ Singh a MBA Graduate from a prestigious Business School In India
Article Published:June 30, 2014

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