In “The Ethical Defensibility of Harm Reduction and Eating Disorders,” Andria Bianchi et al. defend the use of harm reduction strategies to treat patients with severe and enduring anorexia n...

Caring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce. We identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach (...) and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns. The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case. Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption. (shrink)

Patients with severe and enduring anorexia nervosa have a relatively low chance of attaining the symptom-free recovery that traditional eating disorder treatment programs endorse (Bianchi, S...

Bianchi et al. argue that for some patients with severe and enduring anorexia nervosa approaches that do not aim for complete clinical recovery are ethically warranted. We believe tha...

Bianchi, Stanley, and Sutander argue in an insightful, cogent manner for the consideration of harm reduction as an ethically-defensible, non-paternal management approach for capable persons...

Bianchi and colleagues have written an important article that proposes a harm reduction approach to eating disorders that mediates the ethical tension in the l...