Anorexia and Refusal of Life-Saving Treatment: The Moral Place of Competence, Suffering, and the Family

Abstract:
Whether anorexics should be allowed to refuse life-saving treatment is an unresolved issue, which raises acrimonious disputes in ethics and law. I verify whether, and if so on what grounds, anorexics’ refusal of treatment should be respected. I use philosophical analytic methods of investigation, combined with discussion of clinical cases and public attitudes toward euthanasia. Whether or not anorexics should be allowed to die depends not primarily on their competence, as many claim, but on the extent of their suffering and on whether it can be alleviated. This implies that if the anorexic has reasonable chance of recovery, competent refusal of treatment can be overridden. The family should also be involved in end-of-life decisions. Although these conclusions represent a departure from accepted ethicolegal principles, a focus on tractability and on the family has ethical grounds and is in line with the feelings of many on end-of-life issues.