Treatment resistance in anorexia nervosa and the pervasiveness of ethics in clinical decision making.

Clinical efforts to treat anorexia nervosa (AN) are constantly resisted by patients. Although the primacy of patient autonomy is a cornerstone of modern medical ethics, clinicians will nonetheless often be justified in pursuing particular interventions despite such resistance, give the reduced competency of patients suffering from this multifactorial psychiatric illness. While a literature exists on the ethical justification for imposing treatment, that literature has focused exclusively on situations in which patients refuse treatment outright. When patients resist rather than refuse treatment, clinicians are faced with the ethical challenge of deciding whether particular interventions constitute justified infringements upon patient autonomy. Given the fact that treatment resistance is endemic to AN, we see that ethical decision making must also be a continual part of the disorder's treatment. This paper argues that the treatment of AN merely constitutes a particularly clear example of what is in fact a general phenomenon: ethical decision making pervades all clinical practice.