Eating Disorders and Ethics Consultation: Expanding the Dialogue for Pediatric and Adult Patients
Thursday, October 12, 2023
2:30 PM – 3:45 PM ET
Location: Dover C (Third Floor)
Despite the classic portrayal of a White, emaciated, adolescent female, no age, race, gender, body type, or nationality is immune to the physical and emotional devastation caused by eating disorders. Yet evidence-based treatments for eating disorders are limited and designed for adolescents and young adults. Adult patients with treatment-resistant, life-threatening eating disorders have few options, and their providers may wonder whether continued intervention is medically futile. Medical futility is a highly controversial topic; few publications have addressed futility related to eating disorder treatment.
Treatment decisions are further complicated by the impact eating disorders have on patients' decision-making ability, as patients frequently refuse recommended interventions. Additionally, the legal and ethical considerations regarding patient refusal evolve as patients age from pediatric to adult. To promote evidence-based treatments for adults with eating disorders, we must understand the distinct ethical dilemmas that patients and providers face when treating pediatric versus adult patients.
Therefore, we identified the primary ethical and contextual issues for patients with eating disorders seen by the Adult or Pediatric Ethics Committees at a tertiary care hospital from 2016 to 2023. In this presentation, we highlight differences in consult requests between pediatric and adult settings. We discuss the locations where these consults were placed, attending to the distribution of consults between psychiatric and non-psychiatric units. We make recommendations for institutional policy and ethicists and interprofessional healthcare team education. Finally, we discuss the need for open discourse from providers about the dilemmas they face, and how patients may benefit from expanding this dialogue.
Alangoya Tezel, BA – Predoctoral Clinical Ethics Fellow, Center for Bioethics and Social Sciences in Medicine, University of Michigan; Rachel Brownson – Clinical Ethicist, Center for Bioethics and Social Sciences in Medicine, University of Michigan; Janice Firn, PhD, MSW, HEC-C – Clinical Assistant Professor, Center for Bioethics and Social Sciences in Medicine, University of Michigan