Here's a link to the case study for your first forum assignment, and for group work on Wednesday (it's the one we read together in class, in case you want to review).Your forum assignment has two parts. Please complete Part 1 by no later than midnight on Friday night. Your colleagues will need time to read your comment and respond. Please complete Part 2 by no later than midnight on Sunday night.
Part 1
Read the article carefully and think about it for at least 10 minutes before you begin to write anything. Walk around and mull it over for a while.Now, jot your thoughts down in a word processing file or on a piece of scrap paper. I still don't want you to write anything in comments, yet. Think about all of the complicated issues that arise on each side of this issue. What do you think are the best reasons to give people who have severe anorexia nutrition against their wishes? What do you think are the best reasons to follow the wishes of those with severe anorexia, who don't want to ingest any calories? What might someone object to the reasons you've written?
Okay, now compose your best answer to the questions below. Write your answer in a word processing program so that you can edit it easily, and so that it doesn't get lost if there's a glitch in uploading your comments. Include your first name and last initial at the top of your comment.
- What do you think the default rule should be, with regard to people with severe anorexia, who will starve to death without nutrition, but who object to any nutrition? Should they be "fed" against their will (this usually involves a stomach tube or an intravenous line)? Or should we merely provide our best comfort care, and let the disease take its course?
- Why do you think so? Give your best three reasons.
I'd like you to spend at least 30 minutes thinking about and composing your answer, not including the time it took you to read the article. A good answer will show careful reflection on the question; will demonstrate that you've thought about some of the complexities involved and that you've taken seriously issues that arise on both sides of the issue. Further, a good answer will include a detailed explanation of your reasoning. Each of your reasons should constitute at least a paragraph of text. This part of the assignment is worth 75 points.
Once you've finished composing your answer, save it, and then copy it. Click on the "comments" link (in orange) below (the link will say "no comments" if you're the first person to answer, or "# comments" once others have posted). Copy your answer into the text box that appears. Right underneath the comment box, you'll see a drop down menu that says "comment as." Choose "anonymous" and then click on "Publish." Your comment should appear beneath the post. If you comment doesn't appear, send me an email.
Part 2
Give your colleagues several hours to post their own answers to the questions above, and then come back and read the comments. Choose a comment that you think is particularly interesting, and that you think you can respond to in an interesting way.Type your response in a word processing program. Include your first name and last initial at the top of your response.
A good response will push the discussion forward in some way. You might (politely and respectfully) disagree with the person you're responding to and say why; you might ask that person a question to help flesh out her/his idea; you might take the original comment as a jumping off point and add some new ideas of your own. DON'T just tell someone that you agree with his/her comment and repeat their points using slightly different words.
Your response should show carefully consideration and reflection, and should include a detailed account of your own reasons for the ideas you express.
Once you've finished composing your response, save it, and then copy it. Find the original comment that you're responding to (NOT your original comment - your colleague's comment). Click on "reply," below that comment. Paste your response into the comment box that appears. Choose "anonymous" from the drop down menu, and then click on "publish."
I'd like you to spend at least 20 minutes thinking about and composing your response, aside from the time it took you to read your colleagues' comments. This part of the assignment is worth 50 points.
Let me know if you have any trouble opening the link.
Nayeli MC
ReplyDeleteAfter one to five years of treatment or depending on the severity of the condition, the doctor/care facility, the patient's loved ones, and another doctor (who has never treated the patient and is from a different care facility) should have a meeting to vote on whether or not to "force feed" the anorexic patient. A new doctor should be included to provide a new and outside perspective for the situation because the patient's doctor and or loved ones may have unrealistic expectations or frustrations that can hinder their judgement on the needed care for the patient. The patient's love ones, doctor, and new doctor must agree unanimously in order to "force feed" the anorexic patient. If the three groups cannot reach a unanimous decision, then the new doctor must further the patient's treatment at a different facility. If after six months or the severity of the patient's condition does not improve by other methods that are NOT "force feeding," the anorexic patient must be "force fed." This rule should be the norm for anorexic patients because it can take two routes. One route is simply the three groups ( patient's current doctor, patient's loved ones, and new doctor) unanimously agreeing to "force feed" the patient, so the patient does not die. The other route allows for a second chance of treatment that does not include the "force feeding" method. In addition, the decision to "force feed" the patient permits those who are closely involved with the patient to provide their caring concerns while receiving a new point of view. Lastly, if the patient dying, wants to live, but still cannot eat, "force feeding" might be the only way to save the patient's life.
Lucia C.
DeleteI understand where you are coming from, by getting an outside source (new doctor) opinion to the patient’s next step, but I’m not quite sure is the best thing for the patient. If they have gone through this for some time, it means they have tried all things that can be done for the patient. We don’t need an outside source to vote what should be done next. And we certainly don’t need a new doctor for the patient, for no matter of time. The patient is probably already tired and annoyed for all that’s going on behind their backs. All they want is for us to respect their believes. We might not agree with what they think its right, but its something that them as adults want. We should respect their wishes if they don’t want to eat. Yes we are trying to save their lives by giving them the option of nourishing them back to health, but if they don’t want that, then there’s nothing we can do. The family and the doctor have done everything in their power to help them understand. The thing is that the patient knows the consequences for the choice that they are making. So let them make it on their own.
Jaewoo K
DeleteI insisted that we need to consider mental therapy because I believe anorexia is also partially mental illness. If we just try to heal their physical condition, their brain might be going to keep refusing consuming any food, and the situation of the patient will be the same. However, I realized that I did not think about the worst case scenario. Thank you for reminding me that, Nayeli. What if “force feeding” is the only way to keep patient alive? Despite of all our effort and trial, if the patient’s condition is still remaining the same, what will be our next option? Your comment threw the question to me, and I got shocked how foolish I was. “Force feeding” will be definitely our last choice to make, but choosing it is just to announce that we currently do not have any idea what to do for the patient. In addition, what if the patient’s family cannot afford any medical treatment anymore for financial deficit? Do we need to ask the family to make final decision to take the patient home and wait for last minute? Thinking this way make me to feel disappointed and powerless. I hope we will find clear reason of anorexia and its solution soon before it brings more families miserable results.
Marina F
ReplyDeleteHave a team of doctors ready, psychological, emotional, and of course a medical doctor. To have these doctors ready to receive patients with a disease like this one or maybe even specifically this one will help the any patient get the treatment they need as soon as they check into the hospital at any state in the disease. With the question being so broad so does the answer. This disease can take place in any ones mind and impact every individual differently. With that being said the question should not be should they be force fed because that will be decided upon the family and most importantly the doctors after some time in a medical facility. With all three doctors working with patient to help them get to the place that this individual wants to be mentally and emotionally, it is a almost guaranteed positive outcome because the analysis will come from three different perspectives that can possibly connect to one another to form the answer. This also allows this kind of treatment to treat the patient with gentleness and has no room for immediate violence like forcing a tube down someone’s throat against their will. Things like prescription pills and daily routines as such to give the doctors some time to figure out how to help the patient. Nevertheless, every patient is different therefore there will never be a general rule that can fit properly into the entire population of this disease.
Jennifer T.
DeleteHey Marina, I agree with you on the fact that the medical care of an A.N. patient should be multifaceted, but I have a few differences of opinion. In these patients, their disease does not let them think rationally, they believe weighing 45 pounds is too heavy and in their warped state of mind they will do whatever they have to in order to be thinner. Mentally and emotionally this person feels they have the right perspective and that is because it is a mental illness. You can't rationalize with someone who feels it is acceptable to slit their wrists, because in their mind this is what needs to be done in order to achieve psychic abilities. What? That's just crazy right, but you can't convince them of that. They are technically crippled by their belief.
Now I don't like the force feeding thought but I know that you can't talk most hard core A.N. patients out of their thought process. It takes weeks and months and sometimes years to make a break in their defenses, if we did nothing for them they would be dead, and we would have failed yet another tortured human being. Because this only effects like 1% of the population I guarantee there is next to no research going on to figure this out. We know nothing and we treat in the same ways and we get the same results, for the most part. When do you think the docs will wake up and see that if you keep doing the same thing over and over you can't expect to get a different outcome? They need to change the battle plan, try everything else until there is some positive disease control. Mostly, I'd like for us all to see that this is not a choice for these patients, it's an out of control mental disease, a monster that lives inside of them and they have lost all control. Extreme measures might buy enough time for A.N.'s until someone breaks through with some real help. I don't want anyone to give up hope.
Janet S.
ReplyDeleteAnorexia Nervosa (AN) is a severe form of anorexia that takes a huge toll on a person’s body and if it is not caught early on the person can become hospitalized for a long period of time like the three AN cases discussed in the case study. These patients are lacking the nutrients they need to survive and maintain a healthy life. Doctors want to do all that they possibly can for their patients in order to keep them alive but sometimes loved ones and the patients interfere with that process. That is why the default rule for AN patients should be that they be “fed” against their will because they are already lacking so much from their bodies that if they continue to reject food they will die and have absolutely no chance of recovery. Many of the AN patients do not express a desire to die but because their anorexia is so severe the actual disorder does not allow them to eat like patient L for instance. Even if L wanted to eat she could not because her anorexia is so severe she will continue to reject food. By being force fed the patients cannot reject the food. The AN patients should also be force fed because of the fact that due to their lack of food the way their brains function is altered so they believe that not eating at all is the best solution. Maybe if the patient is fed the patient will see that their bodies are reacting differently to the food and they may feel a bit more relaxed and not as tense although the opposite can easily occur. By force feeding the patients there may be a difference in their brain functions and the patients will understand what the doctors are trying to do for them and that the doctors are trying to help them start to recover. By force-feeding the patients, the doctors will fight against the AN and the patients will also start their recovery process. The feeding should be done in a gradual way so that the patients do not suffer from shock with all of the food they are being fed. By gradually feeding the patients, the patients will start to get used to having food in their system and their bodies will be able to adjust to the digestion process in a better manner than if the patients were fed a large amount all of a sudden. Starting with liquids at first will also allow the patients to get used to the feeling of having something in their stomachs and system. From there the doctors can move on to more solid foods. This will also show that the patient can fight through it and recover and that they are not letting their illness win.
Nayeli MC
DeleteI agree that AN patients should be force fed and gradually, starting from liquids to solid food. I completely overlooked how these patients thinking would change because of food in their body, so good point. However, what if the patients' loved ones are against it? Like loved ones of a brain dead patient, they decide to "pull the cord" or not...
Giovanni Prado
DeleteI would have to disagree on the thought that letting them die is the correct course. When should helping someone go and die be the ethical choice in any sane decision. These people who are suffering from Anorexia Nervosa are so mal nourished that they in no way at all would be able to make a decision that a sane person would. It may seem like force feeding is just a quick fix but there have been people who came out better because they were force fed. It should not matter how low of a chance there is, if there is a chance to preserve a life why would u not try and do it.
Francisco A
ReplyDeleteThere should be a consensus among the patient’s doctor and that patient’s loved ones on what they should do next. Since the patient does not want to receive any form of nutritional treatment, force-feeding is the most prominent default rule. The difficulties with force-feeding the patient is that the AN patient him/herself will be resident to this form of treatment, but t may be the only solution to allowing the anorexic patient to continuing living. Therapy can be an alternative solution to convincing the anorexic patient to change their mind and return to a better lifestyle than suffer with a life of malnutrition. Perhaps even joining therapy with force-feeding in a combined solution could be enough to alter the anorexic’s decision. First off the combined solution could show the An patient the negative effects their decision has on hospital in terms of expenses and stress-related incidents to the doctors, nurses, and care-takers to the patient. Secondly, The combined solution would show the negative effects upon his/her family members, as the family would suffer in high expenses, emotional trauma, and even mental stress. Lastly, the combined solution could show the AN patient that everyone around them is trying to help them live instead of dying. Hopefully, the solution could convince the patient to change their mind and fight the disease to live on, but there’s no guarantee that this solution (or any solution for that matter) could help an anorexic patient change their minds. It is ultimately up to the individual/patient themselves to make that change a reality.
Jessica F
DeleteI agree with you that force feeding the AN patient would benefit the patient a lot. The patient would be getting some nutrients instead of no nutrients at all. I think that therapy is a good idea to help the patient also. Maybe by the patient talking to other people in the same situation as them helps them see their problem better. I think that it is easier to relate to someone who has been in your same situation, and sometimes we only understand when we speak to someone who has been in a similar situation than the one we are in. The only problem I see with this is that the patient might cause more harm to themselves if they pull out the feeding tube. Also it is hard to help someone who does not want to be helped. I also agree that the patient's family does have a big role to play in the patients life. But over all I think that group therapy is a very good idea.
Jacob T.
ReplyDeleteA health institute can only provide so much for a patient under their care; how can a physician perform the necessary treatments to someone with severe anorexia nervosa (AN) if they deny the only form of an effective remedy (food). The majority of the anorexia nervosa population is fully aware of the fatal side effects to their condition and as stated the article that AN patients are,” typically not psychotic, and often do not pose an imminent threat to themselves...”, yet continue to not intake the necessary nutrition’s to live and function like a healthy human being. Although the practice of force feeding seems like the only effective way to treat a disorder like this, the concept seems unethical and disreputable by all means. Force feeding a patient can be very traumatic for the patient and their loved ones, causing self-harm, depression, and can potentially worsen the disorder. Force feeding a patient is not fully proven to cure them of AN and is fully understandable why someone with AN would feel violated during the process of being fed against your will. For the patient to understand the harm that comes with this disorder and refuse treatment is no different than a cancer patient refusing chemo or radiation therapy. Their wishes should be respected like anyone else with a disease or disorder, and refusing treatment should be recognized and honored. Therapy and hydration or any other alternative practice should also be offered to possibly cope with some of the effects of AN. Some say that an anorexia nervosa patient can’t make adequate decisions due to the lack of nutrition to the brain and even claim to have, “resistant, deceitful, manipulative, greedy, selfish, and narcissistic” characteristics, the concept of anorexia nervosa patients being forcefully fed against their will, will forever remain controversial and contentious. But through my eyes a non-psychotic being that is fully aware of potentially fatal events without treatment, should have full control over the decisions they make as adults.
Antwan J.
DeleteI totally agree with you. As a patient you the right to either accept help or not accept the help. As a doctor you can only let the person know the outcome of what will happen if the do not eat the nutrition they need for there body to survive and live a normal life with out being hospitalized for the rest of there time on earth. once you become and adult you live with the chooses you make. outside help can only try and get you back on track
Evelin P.
DeleteI agree with your point of view. Not only will they harm the patient but it’s unethical and cruel. Everyone is liable for their decisions and the hospital will not look bad if a patient dies it will look bad if they go against a patient’s wishes and force feed them against their will. You gave an example of a cancer patient which goes very well and also another example can be people who refuse blood transfusions either for religious purpose or morally. They know what the risk are but it’s their decisions and doctors should respect what they decide. If family members and everyone else has accepted it the hospital has no other choice but to accommodate and make their stay at the hospital more bearable. A patient should feel comfortable in where they are going to be hospitalized and knowing doctors could defy their wishes can cause fear and worry to some patients and can be traumatized; force feeding means being tied down restrained and forcefully put a tube down the patient’s throat. If they weren’t psychotic before this treatment could really harm them physically and mentally. The hospital and doctors should just respect the decision the patients make its their life they should have control over it.
Carla P.
ReplyDeleteThe act of force-feeding an individual can be seen by others as unethical, but in some cases breaking down these barriers between what is viewed as right and wrong can be the difference between life and death. A patient with severe anorexia needs nutrition to stay alive, unfortunately this disorder causes them to refuse any food in their system. This force-feeding tactic has been a controversy on whether it should be used or not. In my opinion, this decision should conclude to the opinion of the family and the doctors involved with the patient’s case. If the family and staff decide to go on with the treatment, they must give the patient a chance to go through with it. However if the patient is showing no progress, they will have to notify the family that they must decline furthermore action because of limited resources.
Troy W
DeleteI Agree with you that some may think it is unethical to force feed those with AN, but those that admit themselves to an institution/hospital is a silent cry for “help me.” They can always be with their family and die comfortably in the realms of their own home with no consent from anyone. Once they admit themselves they cross that barrier and the physicians must act on the rules and regulations at that institution/hospital, which is go by any means to keep them alive and not die in their care.
Antwan j.
ReplyDeleteI think this is one of the hardest subjects to talk about, because your dealing with a patient who mentally stable, and understands what there going through. One of the best ways to solve the problem of anorexia, is to find out what triggered that person to all of a sudden not want to eat food anymore. I believe if you if you catch disorder within a reasonable amount of time, that patient would have a better chance of living out there lives. Its hard to change a person when they have lived a certain way for a long time. they have already maid there mind up on how the are going to live out the rest of there life. I think if the patient wants to live, they should present them with a plan to try and fix them problem at hand. if the patient later on refuses to continue the treatment, that person and there family have the right to choose how they live out the rest of there time. The more I think about it , know one should be forced to anything your an adult you can live out your life as you please.
Stephanie G.
DeleteI like that you mentioned trying to figure out the cause or reason for a person's anorexia to be able to better understand what made them become this way. I believe if we can understand them better then maybe it could be easier to find a solution to their situation and hopefully be able to save them before it's too late. Although I agree with that, I'm not so sure about just letting the patient carry on without any treatment just because they don't want to be fed. I don't think anyone really wants to die so why not help them in every way possible even if it means feeding them when they don't want to be fed. It sounds a kind of terrible going against one's wishes like that but if they don't want to die, why not do it? I mean what else can you do?
Evelin P.
ReplyDeleteAnorexia Nervosa is a severe disease for anyone that has it, but it is a disease that could be easily prevantable if the person has adequate attention and care. Many of the patients have had this disorder for some time but hospitals and doctors have not put much attention to their treatment because they are seen as difficult to treat they are “Resistant, deceitful, manipulative, greedy, selfish and narcissistic” as some doctors describe them. It is only when they are on the verge of dying that doctors start to take notice and want to help the patient live, even though they know that recovery is only 10-20 percent. A patient in this situation should have their decisions respected. Doctors should not force feed spmeone who doesn’t want to eat. Patients are compentent enough to know what is going on, they know they are at risk of dying but yet they still don’t want to eat. Forcing someone to do something that they want to do is cruel and can cause a lot of controversy. Many family members over the years have accepted that their loved one has a great risk of dying and they perfer for them to die with dignity and respect. The patients have been suffering for some years of AN and as a patient Green stated that she “would like to be allowed responsibility of what happens next”, doctors failed to treat these patients when they began their illness and now they should respect the decisions that the patients make and just accommodate them and care for them as much as they can without going against their wishes.
Miguel P.
DeleteI completely agree with you when you say that this is an easily preventable disease. If caught early on I feel like the patients would be more cooperative with treatment and it would not be so ingrained in their minds that they can not eat food. The medical system really needs to put an emphasis on catching and properly treating AN early on and after years of the disease has taken such a toll on the patient's body and mind. This kind of a change could potentially prevent many of the cases, such as “L” and “E”, thereby avoiding the question of whether to force feed or not. However is there ever a scenario where force feeding would be appropriate? Lack of nutrition affects the entire body, including brain function, so could it be conceivable that the lack of nutrition may alter the way the patient thinks enough to prevent them from making rational decisions for themselves? I know most of the patients are globally competent however I do not believe that means they are not immune from making irrational decisions about a disease that is affecting their brain function.
Giovanni Prado
ReplyDeleteFor patients like the ones with Anorexia Nervosa there seems like there is no black or white answer to this problem. The patients say they don’t want to die but refuse to eat, which is the only thing to keep them alive. This course of thinking is on the verge of insanity, which is doing the same thing over and over again and expecting a different outcome. This leads me to believe they are not of sound mind and unless their family knows before they had the disease what their thinking would be, then the doctors should be allowed to do what they need to do to preserve the patient’s life. When you get down to it regardless of the situation a life is still a life why would u end it so soon when its already limited to so much little time.
Lorena P.
ReplyDeleteAnorexia Nervosa is more of a mental disorder. These patients are nowhere near suicidal, they want to live. They are competent to know what can happen to them if they don’t receive any care but are in no control. The default rule regarding patients with Anorexia Nervosa is definitely a decision the Doctors shouldn’t make on their own. I believe the family of the patient should have say in deciding what happens with them. I think they should definitely be provided with counseling, therapy, and a nutritionist to help them understand that eating will not harm them. If neither work then “force feeding” may be the only solution to keep them alive. The solution may not sound right or ideal but these patients are at 10-20% of recovering we need to do whatever means necessary to keep them alive. They are being controlled by this disorder we need to accommodate them with “force feeding” as a principal. This disorder being awfully severe may be very traumatizing and scarring for the patient and we may think it is the right thing to do but at the same time it may make the disorder worse.
Lorena, I absolutely agree with you on the fact that anorexia nervosa is a mental disorder, but I also believe they are taking part in an action that can lead to their death. Since it is possibly going to lead to their death, then it seems to me that they are committing suicide. However, I do believe they do not want die. I also agree with you concerning the decision on what happens to the patients. It should definitely be a collaborative decision, but I think it should be between the doctors, patients, and their families, that way every person that cares for the persons well-being can publicly enlist their concerns and can possibly work together for the ultimate goal in treating the patient. I'm not sure if force feedings should be a general but it should be an option for those in a dire enough circumstances. Letonya D.
DeleteTheron R.
DeleteLorena, I agree, these patients are being controlled by this disorder. How do we as a medical care facility respect both the patient's wish to live and also their wish to pursue actions that will lead to their demise? Surely, we should grant them the desire to live and be healthy, and disregard the obvious unsound desire to not be fed. Patients with anorexia nervosa will go to great, painfully lengths to avoid nourishment, and as time progresses their skill in this avoidance grows stronger, more adept. The subjects in question are inflicting self abuse and adhering to an inner psyche that is constantly tearing them down and demanding them not to eat. Treatment must then include feeding, psychotherapy and psych medications to help them make a turn around. We should not be enablers of this disorder, but instead professionals that treat it.
The idea of having a default rule for an issue with this amount of complexity should be out of the question. Each and every case should be evaluated and judged on a case-to-case basis. In the two cases we read, both “L” and “E” had developed chronic cases of anorexia with a with a low probability of recovery. Please don’t get me wrong. I am not saying that just because the outcome doesn’t look very promising all hope is lost and the medical professionals and the patient’s families should give up on them. I am saying that it is a major factor that should be taken into account when the decision is made. Force-feeding should be out of the question for these two patients. Neither they nor their families (being in sound mind) want any intervention from the medical professionals. I feel that the best course of action would be to provide palliative care and keep them as comfortable as possible until the end comes. In the long run letting go will be easier than letting it go on. The families will mourn and the healing will begin. Death is part of life and it is now time to let them go.
ReplyDeleteSandra G.
ReplyDeleteI strongly believe that the default rule for a person who is suffering from severe Anorexia and whose life is in jeopardy should be to be "fed" against their will in order to save the patients life. The case study mentions the following "to allow an anorexic to not eat would be to make treatment of the disease impossible, its kid of hard do treat a dead patient". I believe that as long as the patients has the support and necessary treatment the person going through severe Anorexia can be helped. However, that being said I also beleive that this can only be a short term solution and we need to think about the long term solution for these patients such as medical interventions with doctors, physiologist, counselors and dieticians until they have fully receovered form thier illness. My reasons for beliving this is the physical effects it causes which in most cases all eating disorders can lead to irreversible and even life-threating health probelms, such as heart dieasee, bone loss, infertility, kidney damage amongst other physical effects. Just think about it, if this was a family member wouldn't you do whatever it takes to help save their life? I strongly belive that the probelm can be solved as long as the patient is still allive. Also, we have to keep these patients alive so they can ragain mental clarity as Anorexia accoring the the Mayo clinic can cause protein Malnutrition witch causes brain-power outage. Due to the brains mental and emtotional stability this can alter the brain to not work properly and even fail. And if the only temporary solution is to force feed an anorexic person in order save thier life, then we must do whatever we can to help save that person.
(Supporting webiste for the phsycial effects)
*** http://www.helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm
Maria I.
DeleteI agree with you when you say if we don't force feed them the patients will die and therefore we cant help the patients. I also understand that the patients need intensive care to help them get through their disease, however in the cases we studied the patients have been hospitalized for years. They understand that if they don't eat they will die. They understand the the consequences of their actions and they still refuse the treatment. I also find it wrong to just let someone die but also I find it wrong to force them into anything. But if the patient and their families both have decided that they don't want to be force feed wouldn’t also be unethical to do so? As physicians we have rules and regulations we would have to abide by and also take in consideration the patient and their families wishes.
Gerald M.
ReplyDeleteWe have different opinions and ideas on what possible treatments we should provide to a patient with severe Anorexia Nervosa disorder. Anorexia Nervosa patients are experiencing a severe problem of weight loss and restricted eating disorder. Fear of gaining weight, feeling fat - although super thin, and continuing to diet or starving themselves are common symptoms of a person with an anorexia nervosa disorder. in addition, the article also stated that AN patients are "generally not suicidal, and don;t express an overt desire to die although their actions constantly lead to a slow death." A medical institution should discuss the best possible treatment to the family of the patient with anorexia nervosa disorder. I believe that the institution should start the treatment with AN patient to be force fed as soon as they begin to have expose the symptoms of the disorder. This treatment will give the AN patient the nutrients and vitamins that is necessary to develop their healthy body weight and will keep them from the dilemma of self-starving and slow death. together with this treatment the medical team of the institution should also provide counseling that will be focusing on their attitudes towards food, emotional distress, self esteem, and thinking about their weight. At the same time, a group therapy and a family therapy would also be helpful for the recovery of the patient. The therapy will help bring the person with AN disorder to a hope and confidence that he/she will overcome this life-threatening eating disorder. By providing all these treatment and therapies to a person with AN disorder, the probability that he or she will survive will definitely increase. In my opinion, humans have this natural instinct to help someone alive no matter what the circumstances are. By just providing them the best comfort and let the disease take its course will not help a person with AN disorder as well it will not help the family of that person. You know the person with AN disorder understand his or her situation. Which is one of the reasons why it is difficult to treat someone with this disorder. But, by helping these patients with AN disorder as early as possible, we will keep them from worsening the eating disorder. Show and encourage them healthy eating habits and positive attitude towards body image. Force feeding an AN patient will save him or her from self starving and slow death. He or she might not want to eat but you as an individual does not want to see someone you know or you love suffering and dying. You know yourself can do something, if he or she cannot think of what will be good for him or her. Then you, the person that cares about him/her, should think about force feeding as the best possible treatment for this life threatening disease.
Dave K. I fully agree that early intervention is the best course of action but I think you might not understand the power a disease can have on you and your power to control it. This doesn’t mean that you are not of sound mind but diseases have a way of rationalizing the unthinkable. That’s why it’s a disease. You mentioned that therapy will give a person “hope and confidence” to overcome this disorder. I contend that hope and confidence have nothing to do with it. That sounds like you are saying that positive thought and encouragement will get you through it. By the time they have reached this point the AN has rewired their brain and they are fully aware that it doesn’t make any sense but are powerless to do anything about it, the disease has taken over. The option of force-feeding to increase the body weight of the patient is not a reasonable out come of that procedure. Force-feeding will only deliver the minimum nutrients needed to keep a person alive and is not meant as a way to gain weight. Being alive is very different than thriving. In the case of “L” at 45 pounds, she is alive but I guarantee neither she nor her family is thriving. Loosing a friend or family member to a disease is hard but letting this go on would be harder.
DeleteJacob Tiffer
DeleteAlthough you do prove a point Gerald, I'm going to have to agree with Dave on this one. The idea of force feeding just seems to unethical for me to allow it to happen to a patient who does not wish this treatment. To really grasp this concept I guess you would have to put yourself in ones shoes. Does that patient want to live peacefully and let anorexia nervosa take it's course ? Or spend countless of wasteful hours in rehabilitation-like instituitions being force fed and abused. Force feeding can lead to numerous of other psychological disorders such as stress and depression; not only for the patient, but for the loved ones as well. As I stated in my own post refusing anorexia nervosa is no different then a cancer patient refusing chemo or radiation therapy. Patients who suffer from anorexia nervosa are not psychotic, but fully functioning adults who wish to live their life and only hope for the best. Yes I do agree , therapy will of course be theraputical and healing for the AN patient along with hydration and other alternative treatments. This disease depends on which road the patient wants to go through and can handle as a individual. No treatment should be inforced like force feeding to make it even more hard then what the patient is already going through. As I said before this topic is very controversial and there will never be a right or wrong answer. Just the beliefs and opinions from different point of views.
Savanah F.
ReplyDeleteAnorexia Nervosa is defined as one of the most life-threatening mental illnesses most commonly affecting women. An obvious and (most often times) last resort treatment option is to force feed the patients who’ve fallen far below 15% of their ideal body weight; this aims to restore weight and nutrition in a hasty manner. However force feeding those who have no desire to eat and ultimately try to resist it shouldn’t be the course of action that takes place. A default rule regarding these serious cases is hard to come by, especially since each and every case is different and not every treatment plan is specific to every patient. If I had to decide, however, the default rule should be to provide the patient with the best comfort care coupled with a strong psychotherapeutic treatment plan. Though this illness affects simple cognitive functioning due to a lack of nutrition, patients are still competent and understand the severe health risks this illness presents, yet they continue to have no desire to transpose them. Although they don’t want to consider death as an option, the choice to refuse treatment and subsequently force feeding, is a personal one; physicians and nurses ideally have no right to disregard that choice because the whole idea of practicing medicine and doctoring is based on catering to everyone’s wants and needs, not the other way around. I would agree that as a doctor/nurse, I wouldn’t want to see my patient suffer and basically concede death, so helping them to stay alive is almost an automatic response; however, if their choice was to forgo any type of intervention, then I would respect that choice. If anything were to be forced upon a patient with severe anorexia, it should be intense psychotherapy. Even though the symptoms of this illness are predominantly physical, the source is commonly psychological; anorexia’s earliest stages generally begin in adolescence as body dysmorphia disorder, another mental illness. While the physical symptoms of the disease are hard not to treat immediately, it is important to tackle the mentality of the disease first. Mentally, the patient thinks she is fat. Mentally, she thinks that eating anything will cause her to gain weight. Until that mentality is fixed, the hope of recovery is slim.
Letonya D.
ReplyDeleteIt is my belief to not force feed patients who are suffering from anorexia nervosa. Force feeding patients would only be a temporary action that may not return the patient back to health. Force feeding patients will make their condition worse by damaging their psychological state further. Force feeding a patient can also make them adverse to treatment, which would also bring the probability rate of their recovery. Anorexia nervosa patients use food as a method of controlling some aspect of their lives. The result of their actions will possibly lead to death, but even though they aware of this and don’t want to die, it is their right to refuse life-saving medical treatment. If I was on a hospital board and was trying to create general standards for the hospital on how to deal with patients with anorexia nervosa, I would follow the patient’s wishes. This is an impossible situation and there is no correct solution.
sandra g
DeleteYou mentioned that patients should not be forced feed and should be up to the patients wishes because force feeding the patients would only be a temporary action and that may not return the patient back to normal health. While I agree with you that force feeding can only be a temporary solution. I disagree with you that they should not be forced feed because I think that taking the chance in order to save the patients life is much more important in order to prevent them from starving themselves to death. Even though, it sounds and might be an awful situation for the patient, it is within the best intentions of the doctors and staff in order to help the patient survive.
Veronica P.
ReplyDeleteOne of the patients from the articles we read said that it was the illness stopping her from eating, and not herself. This indicates that the patient does want to live so therefore they should be force fed. The force, technically, wouldn't be against the person, it would be against the illness. I am sure that deep down, the person does not want to suffer anymore, and wants to be cured. If they did not want to be saved, then they shouldn't have checked in to a hospital in the first place. Once you are in a hospital, you are under the doctors' care and it is their responsibility to save their patients. However, dealing with a patient that does want to be saved then they should be force fed. Eating is their only way of recuperating after all. However, I do agree with Letonya D when she says this is "an impossible situation." Anorexia nervosa is a very critical illness almost impossible to get better.
Francisco A
DeleteI like how you have a different approach to this situation. Instead of taking the point-of-view of the patient’s doctors, family and other loved ones, you take on the perspective of the patient as them having a choice in the matter. I agree with you on the fact that the patient does indeed have a choice, as it would make little sense for the patient to be in the hospital if they did want to be helped. Then again, it could be just as likely that the family forced the anorexic patient to be in the hospital against their will. Who knows, but I do fully understand where you are coming from and (again) I agree with what you have to say. Of coarse, though, you didn’t quite explain what procedures the doctors should take in detail, but it’s still a good explanation overall.
Miguel P.
ReplyDeleteI realize that my answer may not actually answer the question posed but it is how I feel about how we should handle the treatment of Anorexia Nervosa. Here it goes. I do not believe that there should be a default rule at all with treating this disorder. Anorexia is an extremely unique disease in the fact that there is no way to medically treat the disorder except for therapy and intervention. You can treat one of the main symptoms of the disease, namely malnutrition, by force feeding someone but that doesn’t actually cure the disease because all that is achieved is treating the malnutrition, however the decision as to whether to force this kind of treatment on a patient, I believe, should be left up to the attending doctors and family members as each case is unique. Each patient may have different severities of the disorder, different lengths of time that they have been affected by the disorder, different levels of maturity about their problem, and even different outlooks about their disease. Someone who has only had the disorder for one year, is only 15 years old, and is in complete denial about the fact that the disorder will eventually kill them should be handled completely differently from someone who is 40 years old, has been dealing with anorexia for 15 years, and fully understands that their life is in danger and still refuses treatment. When someone is young and in denial about their problem the parents or guardians should really be the ones deciding whether or not to force feed or let their child have his or her decision stand. When it is an older person who has been battling for an extended period of time what makes it different from someone with cancer who has decided to stop chemotherapy? For an anorexic, the food is like the chemotherapy. The mind of the anorexic is so set on the belief that food is bad for them that their body actually responds negatively to food and so does the patient receiving the food. The placebo effect is something that mainstream medicine has recognized and it would apply here too. Would you, as a doctor attending to a patient with anorexia be willing to force something into someone under these kinds of conditions? These are decisions that need to be made by a person or a group of people and not by a general rule of thumb. It is these kinds of variation on a case by case basis that makes me believe you can not put a general rule of practice over; even if it is more of a guideline than a law.
Maria I.
ReplyDeleteAs a doctor i think theres so much they can do. They can advised a patient of what the best treatment is. Give a patient options and the consequences that come along if they choose not to accept the treatment. I can understand that AN is a severe disorder that is a psychological issue. In sever cases where a person has been hospitalize for a long period of time it would take a lot of work and effort from the doctors and the patient. I think the patient would need intensive therapy to deal with the psychological issues that cause the AN. If the patient has already tried that treatment and no results have concluded from it i don't think force feeding the patient would make a difference. The patient is at a stage were they have been living with the disorder for almost all their life it will be hard to convince them they need to change the way they live soon or they will die.The patient is at their full capacity to understand the consequences of their decisions and if the family agrees with the patient all we can do is accept their decision. Not every person suffering from AN can receive treatment. People who want the treatment and are willing to do what it takes to fight the disorder. I find it unethical to have to force anyone into any type of treatment. All we can do is respect the patient and their families wishes.
Siriphone R.
DeleteHello Maria! Your response is exactly why I kept going back and forth myself. I just could not figure out whether it would be a good or bad idea to force feed. I do too understand that force-feeding someone who does not want to be force-fed is wrong. However, though I was going back and forth I still do not think I can agree with you. If someone is lying on their deathbed and telling me to allow them to die, I just do not think I can get myself to do it. I just keep thinking of it as someone I care about wanting to give up. What would you do if it were someone you love that wanted to give up? Would you allow them because you want to grant their wish? I think it is just tough when it is someone you care about on that side
Kiran K.
ReplyDeleteIf a person has Anorexia, they should go to the doctor for the six month checkup. If any case a person is diagnosed with Anorexia they should do their own research. They should do their own research on how to cure themselves. They should by the doctor's approval slowly eating more. It's not good to force anyone to eat more food than expected. They can start out with fruits and nuts and then go up to meat, if they are vegetarian than more food beside meat. If they are in a health condition where they can’t eat properly then they should be given food by a pipe, then slowly exceed the amounts. If they are trying to lose weight then they should watch their limit before becoming Anorexia because cutting off food all the way can cause big problems. It’s best to eat a little than not eating at all. A lot of models like to become Anorexia but it’s not good for their health. People should take lessons from those who have Anorexia because once a person becomes Anorexic it's too hard to recover.
Madhuri D
DeleteI agree with you that patients shouldn't be force to eat more than expected but what if they don't eat at all? Yes we can always start with less amount of food and we can go up to heavy meals.Food plays important role in our lives without food our body wouldn't function well. It's always better to try rather than doing nothing in addition to that I also like how you gave examples of models because there are few people who are unaware of anorexia.
TroyW Anorexia Nervosa is a disorder or addiction, which at times becomes life threatening for individuals that have it. Those with “A.N.” can’t hold down food nor get the nutrients needed to survive. Treated at the early stages, it can be overcame and treatable. Unlike patients E and L the stages that they’re in, its came to a point where they may have to be force fed. The default in that is that it violates the rights of those whose wishes are to die comfortably in that state. Force feeding is then the only option because it is cruel and unusual punishment to let anything living die in that fashion. Secondly, if at any reason they’re admitted in any institution and/or hospital, by law they’re guidelines and regulations to abide by to avoid any lawsuits. Finally, force feeding will then give them a second chance to live and a better chance of rehabilitation understanding just how precious life is and while recognizing what they’re putting themselves and family through!
ReplyDeleteCassandra D.
DeleteI completely agree that perhaps force feeding would be the only option to treat AN patients. I also like that you mentioned AN as an addiction because for patients like E and L, starvation gives them a sense of pleasure. Now, although I agree with your points, I wanted to point out something you said. Do you think force feeding is not a cruel and unusual punishment? People who are against such treatment would say it is a cruel punishment.
Michelle P.
ReplyDeleteAnorexia is a disorder that affects a patient health: mentally and psychologically. Patients with anorexia are mentally and psychologically affected because they want to be "skinny" and they think they are fat when they eat. The patients are affected because they don't have enough nutrients in their body nor brain to help themselves. I think that the default rule regarding to people with anorexia should be to force feed them until they can see a change. Unless the patient just quits and doesn't want to be helped. A doctor and loved ones can only do so much to help the patient. They are also affected emotionally because they see what the patient is going through and they want them to get better. For instance, the second case says that patient L did not want to die but her anorexia wouldn't let her take in food. In these cases, I think doctors should get together and find a way to try and help the patients eat something and console them so they have a better mentality. Forcing foods to patients can help them
gain nutrients and would help them mentally. I also think that in order to help the patients they should give them advice to help fully recover. Doctors should also help prevent others from getting anorexia and saying the consequences a person can get. That is why I believe force feeding can probably help an anorexic patient recover from the disorder.
Oluwatomi A.
DeleteHey Michelle I mostly agree with what you said and i enjoyed reading your post, However you said the default rule in this situation would be to, "force feed them until they can see a change. Unless the patient just quits and doesn't want to be helped." Forcing the patient to eat means that they have already given up on helping his or her self anyway. So would you still force feed them even though they have already given up on eating and is extremely against anyone feeding him or herself?
A change as in an improvement is what I meant and I agree that forcing the patient means they have already given up. You just cleared that up for me, thanks! But to answer your question, I would still force them even though they've given up even if it has to be with a tube because I would want their health to better.
DeleteJaewoo K
ReplyDeleteWe should not force them to consume any nutrition while they reject it. Our default rule should be respecting their will. However, we should not give up the patients even though they just want to stay in current situation. We must let them know well about their own illness. The patients must know they will die for sure if they keep refusing consuming nutrition. And if necessary, we should offer them mental therapy to motivate them to eat, to live. The patients must know how people around them would feel if they just die by refusing foods. How sad and miserable the feeling would be. We could ask the patients’ emotion if there is any possibility to compromise. Follows are the reasons that I came up with my conclusion. First of all, I believe we cannot force them to be fed because of dignity of the human beings. No one’s life is less valuable than others. We should put all of our effort to let them live as we do for cancer patients. Second, we should consider will of the patients. They do not want to die. If they understand there is only one result waiting for their decision, their mind might move to change the tragic consequence. For third, we must remember people around them, loved ones. The obvious result will hurt them mentally, physically, and also financially.
Nhu T
DeleteRely to Jaewoo K
. I totally disagree with you when you say “The patients must know they will die for sure if they keep refusing consuming nutrition”. In this case, the patients who have AN, patients can’t eat and they’ve known that if they don’t eat they will die, but they don’t want to get treatment and they want to die. They’ve been hospitalized for a long term, but it is not getting better, so they want to give up to reject the treatment. The argument here is if they don’t want to eat and they want to die or they don’t want to die but they just can’t eat to get nutrition to maintain their live. Will doctors and people in the hospital should force feeding them or follow their willing to let them die? What is your statement and you have any method to solve this problem? Therefore I think your point is totally incorrect with the situation. I agree with you about “Our default rule should be respecting their will”, doctors and nurses have always had to respect patients wishes to satisfy them to get the best treatment. However, I strongly believe that it is inhuman more than the force-feeding method when you allow people die while you can keep them alive even they don’t want to live. It is just because they are hopeless, not because they can’t live anymore. It is not the perfect reason for wasting somebody’s life I believe.
Eric S
ReplyDeleteAnorexia Nervosa (AN) is a mental disorder and doctors should treat people suffering from the disease as if they are treating an addict. Depending on the severity of the patients AN, Impatient therapy and or psychiatric counseling should be implemented the day the patient seeks the help of medical professionals. In the hopes of successful treatment when treating a person suffering from AN, the individuals family must be involved and helping every step of the way. We can only guide the individual, and their families into living a healthy lifestyle. If treatment fails and gets to the point where the patient is hospitalized, force-feeding via intravenous tube shall be administered. To let the patient starve to death in the hospital would be assisting suicide. It is the hospitals responsibility to do everything they can to get this individual healthy enough to go home to their families. Take for example a person suffering from heart disease that needs heart surgery due to the fact that they are eating too much sugar and fats. It is the hospitals responsibility to fix the short-term problem, and the individuals (and families) responsibility to stop eating the sugary/fatty foods. The same should go with a person suffering with AN, the hospital and doctors should fix the short-term problem and it is up to the individual and their families to start living a healthy lifestyle. Of course medical professionals should guide the patient into counseling and other forms of treatment upon their release from the hospital.
Jessica F.
ReplyDeleteI think that is wrong to let someone die if they can be helped. I feel that people with anorexia should be helped in someway. If people with anorexia want to be helped and their family members agree, then being fed by force should be allowed because the patient wants the help and is willing to try to change.
I on the other hand do think that a patient has the right to refuse any medical treatment. If the patient does not want to be fed by force then they should not be. There is no point in putting a feeding tube in someone who does not want one. The feeding tube can cause more damage to the patient because they have to have surgery done to install the feeding tube and that might cause the patient a lot of pain. Also if the patient does not want to have the feeding tube in them then they can pull it out causing themselves even more pain and harm. Instead of force feeding a patient they should be given the option to eat or not. There are many things that can be done to help a patient want to eat. An idea to help the patient eat is to find out what their favorite food is. After finding out what there favorite food is then they can be given that specific food daily so that they can eat something instead of nothing at all. Just because a patient does not want any treatment or food does not mean that they should be ignored by the medical staff. Even if the patient does not want to eat they should still be offered food, water and some medicine to relieve any pain. Some of the food that can be offered to the patient should be high calorie snacks. There are also some medications that help to stimulate a patient's appetite so that they can want to eat.
Michelle P.
DeleteHi Jessica, I completely agree with what you said about someone being helped in someway because I believe somehow they can defeat anything if they wanted too. If they have Anorexia, who knows if they'd be able to eat their favorite foods. What if they're favorite food was unhealthy, fast food, would you still feed that to the patient? I understand its food, but it is unhealthy.
Jessica F
DeleteYes I would feed the patient junk food if that is their favorite food. It is unhealthy for them but I would prefer the patient to eat something instead of nothing. Also maybe eating their favorite food will trigger something in them that will make them want to eat something else, and maybe they will get a craving for another food. Also after eating the same food for a few days they might get tried of it and decided that they want to eat something different and then they can start thing of other things that they use to enjoy eating before.
John S
ReplyDeleteI believe that a patient who is deemed “competent” has the last say in his or her treatment. However, I do feel that it is the moral and legal responsibility of the hospital to offer its services. If a patient expresses a will to live but not eat, they should be offered alternative treatments such as hydration or nourishment through an IV. If a patient is considered to be “incompetent”, I believe the decision should be held with their loved ones. Ultimately everyone deserves a chance at life; but just like any other medical procedure, the approval of any treatment is held with the patient. In a scenario where the competent patient refuses to eat and refuses any other treatment that involves nourishment, I believe the hospital should allow the disease to take its course. I feel that if someone does not want to eat, feeding them against their will only prolong their suffering. After being nourished back to health, they may return to the hospital with the same conditions. I also believe that quality of life should be considered after expressing a will to live but not eat, to stay alive but be force fed everyday in order to live sounds gruesome and painful. After years of treatment and counseling, AN patients are often aware of the effects of this disease; if they openly deny the intake of any calories after being offered treatment from professionals and specialists, I think their decision should be respected.
Angad S.
DeleteJohn S. I completely agree with you when you say that " you believe that a patient who is deemed “competent” has the last say in his or her treatment, and I also believe that the moral and legal responsibility of the hospital is to offer its services. The hospitals and there staff are here to help the public, but what if the public, in this case the patient doesn't want to be helped. What if the patient has been suffering for over 10 years, knows what she or he is suffering from, knows that the only way to beat this is through food and nourishment and still chooses not to eat. Then I think that the patient should be allowed to make the decision for him or her self to chose to wither away and die because its already been 10 years or more of suffering without any progress.
Siriphone R
ReplyDeleteThis was a really tough topic to think about. I constantly went back and forth trying to figure out what would be “the right thing to do”. Then it hit me when I thought of the person being “force fed” was someone I love. I would love to give the person that I love what they want. However, if it is between life and death I do not think I would let them give up without a fight. I would not be as understanding and allow them to stop eating. I understand that there is a possibility that the patients may end up losing it after being force fed but if there are that many support (family, friends, doctors, psychiatrist, shrinks, etc.) then why not just force feed. I strongly believe that as long as the patient can stay alive then there are possibilities of being brought to being healthy after being force fed. I do not think anyone who wants to die is clearly thinking. I believe those who want to die is only thinking for the moment. I also believe that if the patients who are anorexic are used to hearing negative results. I think that if the patients begin to hear positive results then they would think a lot more positive, mentally. I know this should be the least most important matter but I also believe that it would not be a really good look for the hospital/doctors if they allow someone to die.
Veronica P.
DeleteSiriphone, you make an excellent point in putting yourself in the family's shoes. As I read your comment I put myself in the shoes of someone who's loved one is going through AN. These patients don't want to die. They are aware that they are sick, and although they refuse to eat, I truly believe that it is their sickness stopping them from eating and not them (like one of the patients we read about said). If my loved one was going through this terrible situation, like you, I would not let them give up without a fight. Force feeding at this point is their last option, and if it doesn't work, well it didn't, at least you can say you tried and you didn't just let someone die. They're mentality has also completely changed. This illness has caused them to think that they don't want to eat, and that the want to die. It is like the devil over their shoulder has completely taken over. However, deep inside I know these patients want to be cured. They are young, and I am sure that they don't want to let their future go and their loved ones go without a fight. Force feeding sounds unethical but it is their last choice. There could also be the possibility to have the patient go through intense therapy first in order to change their mentality and then be able to feed them more easily. Other than that, force feeding is their only option. The last point you make is also very interesting. I also believe that if the patient checked in to a hospital then they want help. Once they are under the doctor's care then they are bound to be put through anything in order to be saved. It is the doctor's job to save lives, not to give up on someone just because it is difficult to save them. What kind of doctors would they be if they just let someone die?
Oluwatomi A.
ReplyDelete1. I feel that the default rule should be that people who suffer from severe Anorexia should be forcibly fed proper nutrition through any means necessary. However this would only be done until the person is deemed nutritionally sufficient in order that their brain can function properly and the person in question can coherently think. Furthermore, during this process the person should undergo prolonged extensive psycho therapy in order to resolve the distortion concerning food of this person. However, if this person continuous to in their initial stance to not eat, even after extensive therapy and achieving nutritional health, then the person should be left to their decision to not eat and inevitably die. Also, comfort care will only be provided for those with insurance or money to cover for it because it is their decision and they have full knowledge on the consequences. As a result, those who do not have insurance or money will unfortunately experience the pain of their bodies slowly shutting down.
2. I would implement this because everybody is entitled to their own choices and in this case if such a person is taken care of without insurance or money then the money will be paid for by someone else who had no part in this choice which I think is not fair. Moreover, such a patient can not be forcibly fed indefinitely because at some point the patient will either have to be self sufficient or die. Consequently, I feel that force should no longer be used after the person is healthy in the aspect of nutrition. Finally there must be psychological intervention being that this is a psychological disorder.
Lucia C
ReplyDeleteThere are a lot of people out there that are pro anorexic and say Anorexia is more of a lifestyle than a disease. People chose to take this path in their lives. That’s what they like, and no one can change their mind. It doesn’t mean we can’t try and explain to them that the “lifestyle” they have chosen, isn’t the right path to take. The thing is that they already know all the consequences that come with it. If the path that they have chosen takes them to the ER now, then it really becomes the Hospital’s problem to try and help them as much as possible. Help them as to let them come to realize that what they have been doing to their bodies is not good at all. Drill it into their heads and try to nourish them back to health. Not to comfort them to die for the path they think is right. When there is a way to save some ones life, it is our duty to do everything possible to keep it going. If the patient denies out help to try and cure them, and all they want from us is to try and help them relieve the pain, then there is no reason for them to be in the hospital in the 1st place. They knew the consequences when they chose the lifestyle, now let them suffer for their consequences. There are a lot of people who need help and actually want it. We shouldn’t be wasting time and effort on someone who doesn’t care.
Janet S.
DeleteLucia, I agree that Anorexia is more of a lifestyle choice but it escalates and gets too far to the point where the person can no longer control the fact that they are not eating. You also have to take into consideration the fact that they are lacking so many nutrients in their bodies that it is affecting their thinking and they have gotten so used to not eating that that is all that they believe is the right thing to do. Obviously the illness has gotten to a very extreme point that leads them to be hospitalized and it is the responsibility to try and save the patients life. You are right that these patients have chosen this lifestyle for themselves but at the same time we do not know what they are going through or what caused them to start starving themselves. Like the article says that part of the AN is the patients rejecting food so regardless of how ever many times the doctors try to feed them they will continue to deny the food so force feeding them would be the only solution. These patients will continue to deny any type of food until they are in a better state of mind because the lack of nutrients causes the brain to function differently. You say that there is no point for having someone in the hospital that just wants their pain to be relieved and that it is waste of time and effort, but how do you know that the patient does not care what if they just do not know what the right thing to do is because they do not think properly like someone who is healthy and is not lacking any nutrients in their body? Would it still be a waste of time and effort to help someone who just does not know if they should go against the way they have been living for a long time knowing that their lives are at risk? How do you know that they do not care about their health?
Eric S
DeleteLucia, I agree with you when you speak of the patients suffering from AN and how it is the hospitals duty to "help them as much as possible". However, I disagree with you when you say the patients choose this lifestyle, that this is what they like, and that they should suffer for their decisions. These people are suffering from a mental disorder that was triggered by something traumatic in their lives; they did not choose this lifestyle. We are not wasting time on someone who doesn't care, we are helping a person who cannot make a responsible decision due to their mental health. We should focus on getting them psychological treatment and if force feeding is needed to get to that point, then this needs to happen. Life is precious and these patients are suffering from a mental disease, they deserve a little more sympathy. We can at the very least guide them into making good decisions regarding their lifestyle by introducing the patient and their families to trained counseling for AN.
Cassandra D.
ReplyDeleteAccording to the article written by Tetyana Pekar, “the inability to eat enough to maintain a healthy weight is at the center of [the] disorder.” Thus, if force feeding is a solution or a way to treat this disorder, it may just well be the necessary action to do by the doctors. It may not seem to be a humane answer to an extreme and delicate illness such as AN, especially in which the patient’s say is in question. However, if there is a way to be able to prevent people with this disorder from dying (or at the very least help prevent the illness from worsening) , then such measures should be taken.
In terms of just the physical aspect, for their sakes, this could be the only way to provide them with nutrition. There are those who might not be able to adhere to the regimen, but there also has been reports of those who were able to recover from it.
As mentioned, many would probably argue that it is the patient’s right to refuse treatment seeing as that they are not mentally incompetent and can clearly distinguish the dangers of their circumstance. But, whether or not they know what does or doesn’t kill them should be out of the question because, just as explained in the article, this is the illness speaking, “winning.” Just like with L, she understood that it was her anorexia stopping her from eating. It really would be akin to murder if we or the doctors would allow them to die.
Cassandra, your points are strong and valid, they made me think about the case study from a different angle. I agree that life should be preserved and protected for everyone; but I wonder if the quality of life being force fed everyday to maintain a minimal level of healthy nutrition is a life that a person can enjoy? In a case where a patient expresses the will to live and acknowledges that the disease will not physically allow them to eat, rather than refusing to eat, I agree with your approach. However, I feel that if a competent patient refuses to eat, it would be wrong for them to be force fed. What are your thoughts?
DeleteJohn S
Cassandra D.
DeleteIt's interesting that once an anorexia nervosa patient who refuses treatment is force fed that we think that they would have to be force fed for life. Of course we wouldn’t know exactly what the outcome would be, but I’d like to think that doctors wouldn’t have to treat them that long for them to understand that they should overcome such illness and appreciate life more. Moreover, I believe that competence shouldn’t be a factor since most AN patients are competent enough to know the risks of their actions but still refuse treatment or any type of intervention. And this is solely because of their disorder, which, again, is winning. Perhaps, we can view AN as an addiction. And this example may not be the best analogy for an extreme illness like AN, but let’s think about minors who are addicts. Pretend there is a 15 year old drug addict who knows what he’s doing is wrong but is unable to quit because the addiction is very strong. Then, maybe, his parents would force him to undergo rehab and, after a few years or so, he has recovered. What I’m trying to say is that it doesn’t matter if the patient is competent or not because evidently the illness is still taking over and that it might not even have to take a lifelong force feeding treatment for an AN patient to be able to recover. So, a different approach could be that doctors can try out a certain duration for a patient to undergo the force feeding treatment and if relapses keep occurring or if there are no positive results or when that duration of treatment has ended, then the patient can choose whether to continue or simply just let the illness to completely take over.
Madhuri D
ReplyDeleteThere are numerous people suffering from anorexia and they don’t want to put single grain in their body. Anorexia can be very dangerous at that point you want to starve to death. I personally believe that in order for people suffering from anorexia to keep healthy and safe we should force fed them. As, a human it’s our responsibility to help other human alive. In this case if we don’t force fed them then they won’t get nutrition to function in their body system. Our life is incomplete without eating food because it’s important part of our lives. I would recommend force fed the patient even they don’t want to because I wouldn’t want anyone to feel guilty about it for not trying.
Kiran K
DeleteI agree that they should force fed but at the same time they should not because sometime its too hard for patience to do what their doctor tell them to do. Feeding them a lot can cause hazards to them. we should talk to them or discuss with someone who in charge of that patient about what would be a good choice for them. Yes everyone would love do anything to help a human but we can't force a person to eat but we can definitely find a solution to make them eat.
Angad S.
ReplyDeleteAnorexia is a horrible disorder and my sympathy goes out to everyone that suffers from this slow killing disease. From my point of view there are three different sides to figuring out the right thing to do in this situation. First I believe that there should be a professional psychiatric screening of the patient to see if he or she is all the way sane and capable of making the right and healthy decision for his or her own wellbeing. If the patient is declared sane after the psychiatric evaluation, then the decision no matter to live or to die should be left up to him or her. The second perspective to this horrible scene would be from the loved ones, close family or relatives of the patient. If the patient is declared not sane or not capable of making healthy decisions for his or her own wellbeing then the closest family member i.e. (father, mother, sister, brother) should be the ones that decide whether to force feed or pull the plug. The type of medical care involved in this case sounds to me like it would be expensive. As long as someone cares enough and is willing to come out of pocket and take care of medical expenses then the decision should be up to whomever is paying the bills. I believe that if they care enough to sacrifice hard earned money for the wellbeing of their loved one then all the help in the world should be given to the care and rehab of the patient. The third and last scenario to this story would be the one from the doctor’s perspective. If the patients psychiatric test come back negative which mean that he or she cannot make the right decision for his or her own wellbeing and he or she has no family members present or that care, then the decision to live or die should be left up to the professional judgment of the doctor. Doctors that see and treat this type of sickness all the time have the best judgment about whether the patient seems like he or she can or cannot make it through something like this. I totally understand that doctors are not mind readers nor can they see into the future and give a 100 percent answer to whether or not the patients will power and want to live can overcome such a horrible disease and make it, but I do think that they are around enough of these patients to know which one has a fighting chance and which ones are slowly withering away. This is truly a horrible disease that claims many lives each year, I would never wish it upon anyone and feel bad for anyone that has it. Life is precious, tomorrow is never promised and good health should never be taken for granted.
David B
ReplyDeleteWe live in a world where the utmost importance is placed on outside beauty rather than what’s on the inside. As a result, we have eating disorders and confidence issues coming about and take its toll on society, both financially and physically.
In my personal opinion, someone should only receive artificial nutrition only if they have gotten to the point where normal functioning is impaired, meaning, the ability to think rationally, possibly going unconscious due to the lack of nutrition, and unable to make decisions for themselves, and all other methods of therapy have failed. In the case of minors (< 18 years old), it would be up to the parents at that point, but for the adult, doctors would have to consult with their partner/spouse, closest family, etc and explain to them what the situation is. Ideally it would be easier to arrive at a decision if that person had some sort of advance directive, so their wishes are clearly stated.
I’ve always been taught that if a patient is alert and oriented x4, they have the right to refuse whatever they want. As discussed in class on Monday, most of these patients that have severe anorexia are aware of the possible outcomes of their disorder and don’t really wish to die, but instead linger, possibly to cause psychological trauma to other people with their “cries” of attention and their slow death. However, they have the right to refuse food, because they are still able to make decisions for themselves. Some people may say “the disorder is affecting their ability to make rational decisions” and then ultimately results in someone being 5150’d to a psych facility for further evaluation and treatment. I see it all the time. This is sadly a product of our own society. I believe that it takes detection at an early stage (like any other disease) and intensive counseling by a team of specialists (psychiatrists, doctors, nurses, etc).
At one point, doctors were indeed patient advocates by acting out of concern for the patient suffering whatever condition, but in the age of the myriads of insurance paperwork and limitations on how much insurance is willing to cover, a lot of doctors are just merely scratching the surface, combine that with a society that places emphasis on the idea of thin being beautiful, all contributes to the increased incidence of anorexia nervosa diagnoses in our country and across the world.
Nhu Tran
ReplyDeleteFor decades, people have studied and given research about human brain and mankind, which are different with animals. Why are animals do not have their mind or express their thinking by action as same as human? I believe that human have capability in both physical and spiritual to have senses of understanding which one is correct or wrong behavior, knowledge about meaning of live and death, and love between people around the world. We have our soul, feeling and heart. Therefore, letting people die while they can live, is a wrong behavior in this world. In the case of anorexia nervosa (AN), the patients don’t want to die because they can’t eat or they don’t want to live anymore, either they don’t want to get treatment. Should the doctors and nurses let them starve to death? I strongly believe that it is not a human sense to let patients die if they want to and people should not treat others by giving them a chance to die. It is not different with murder. It is killing behavior, but not helping people satisfy their willing. Doctors, nurses and patient families have their heart and soul, they love people and their families, and they don’t want to see people around them die because of illness. They can’t avoid their responsible for the patient life. They can’t ignore it. Doctors, nurses and their families are also extremely hurt if they see the patients die while they can live longer if people help them. Patients just need help. Why do people want to become doctors and nurses? Is that because they want to let people die when they don’t have ability to save people life? Will they feel comfortable for the rest of their life and treat other patients well if they used to kill patients. What about the future of medical career? Do people help other people die, but not save their life? If the patients don’t want to live, and I’m a doctor I won’t satisfy patients by letting them die with their illness. We shouldn’t have law to let people die. It is horribly for the community if that law is existed in this world, I believe. Doctors, nurses and families should be the one who encourages patients to continue to receive the treatment in order to waste their life just because they can’t eat. There is just one life to live. If patients have already been in the hospital for a long time, for instance 15 years, although they wasted too much money, endurance and time, there is no reason for them to stop trying and doctors should help them, not to support their willing to die. Patients can even be in the hospital for 15 years, why would they don’t want to stay in there longer to live better? Patients want to live so they came to the hospital to get treatment. They don’t come there to stay in the hospital for a long time and when doctors can’t help them, they should die because the treatment is not helpful. Why people have to come to the hospital? They should die earlier instead of come there and wasting their time, money and scarify for it. When they let patients die, why would the hospital maintain their career? I think that patients deserved to have psychiatric treatment while their mental is incompetent as same as others who are their families and doctors because they feel hopeless. If the treatment is not efficient, they should force the patients to be fed and keep them alive. It might hurt patients in physical, but this is the only way that they can live and also show the patients that people around them still care and want them to be exist and it will hurt others feeling if they die.
Maria I.
ReplyDeleteAs a doctor i think theres so much they can do. They can advised a patient of what the best treatment is. Give a patient options and the consequences that come along if they choose not to accept the treatment. I can understand that AN is a severe disorder that is a psychological issue. In sever cases where a person has been hospitalize for a long period of time it would take a lot of work and effort from the doctors and the patient. I think the patient would need intensive therapy to deal with the psychological issues that cause the AN. If the patient has already tried that treatment and no results have concluded from it i don't think force feeding the patient would make a difference. The patient is at a stage were they have been living with the disorder for almost all their life it will be hard to convince them they need to change the way they live soon or they will die.The patient is at their full capacity to understand the consequences of their decisions and if the family agrees with the patient all we can do is accept their decision. Not every person suffering from AN can receive treatment. People who want the treatment and are willing to do what it takes to fight the disorder. I find it unethical to have to force anyone into any type of treatment. All we can do is respect the patient and their families wishes.
J.Hornesby
ReplyDeleteI don't think anyone should have any thing done to them against their own will, even if it's thought to be being done for their best interest. These patients are beyond the point of return and as unfortunate as it is the disease has power over them, so forces feeding could help however; I feel that it will only prolong the inevitable and cause more suffering for the families and patients. For that reason as well as it goes against the patients and families wishes, and it is inconsiderate to the patients want for dignity I feel the patients should be provided with the best comfort care the hospital can provide. ________________________________________
Marina F.
DeleteJ i completely agree with you on the disadvantages that forcing feeding has. The fact that it has to be forced upon a patient that is already going through a hard time dealing with a disease, this force only corners the patient further into the corner that they had already started in. although i agree with your logic i want to learn more about what you think we should do that can substitute this treatment. Providing the 'best comfort care' does not really say much on what actions the doctors should take to male sure the patients do not have to go through such force even when it comes down to the only option available. Do you think this action should at least be decided by the family only? What if it was a decision only the doctors are able to make would that be fair? how many people have to agree on this kind of treatment? should it be banned completely? i only ask so many questions because i feel as though we have the same train of thought that keeps going back and forth between trying to save the patient at all costs then again putting yourself in their shoes and being against something that makes an individual feel as though they have no control over their lives and feel as though everything is against them. No matter what the plan is these doctors have always treated their patients with care not an individual goes by that gets a tube down their throat because they are not in the right hands. Taking good care of a patient takes guidelines, a game plan; something to abide by when these situations get tough. after all, we are only the outsiders and these decisions are taken by the people personally involved in cases like these.
Stephanie G.
ReplyDeleteI believe that people who have severe anorexia and are being hospitalized should definitely be "fed" even if it's not something they want. I say this because if you're at a point where you need to be hospitalized because you're on the brink of death, then you should expect to receive whatever it is you need to live. The article mentions that the patients didn't want to die, so why not let themselves be "fed." A lot of people would say that it's not right to force these people into getting the nutrients they need to live but when you're at 45 pounds and dying, I think it's okay to do so at least until they can get them to a certain point where they can rethink things an maybe talk to a professional about their condition. I believe that these patients and their loved ones that care about them will appreciate it in the end.
You make a good point when you say that if they're hospitalized based on their fear of the death of the patient that they should expect to receive whatever it is they need to stay alive. However, what if the patient were to be force fed, they get better to the point where they're released, and then a month later the same patient gets readmitted to the hospital because of relapse; do you think that the patient's loved ones will rethink how they handle treatment then?
DeleteSavanah F.
Gerald M
DeleteYour definitely have a great point. I believe that force feeding is so far the best treatment for severe cases of anorexia nervosa disorder at this point of time. They might know what they are doing and knowledge of their eating disorder, though they do not know how to make good decisions for themselves. It is very important that at this point of time, we should not be hesitant to help and make a move that will change their lives. AN patients can't help themselves, so giving the best treatment and immediate care they need, it will have a positive outcome in the end. Doing so, will help these AN patients and their loved one at the same time.
I feel that it is not O.K. to FORCE anyone to be fed even if they are unhealthy. If they know all of the risks that are associated with their disorder then it is their choice. If you're on the brink of death then more than likely it is too late and your body is past the point of no return and the treatment is a waste of time and resources.
DeleteAnd if you have already refused treatment and given up the will to fight your body will more than likely reject treatment and you will be going through the motions to make someone else feel better about themselves.
Theron R.
ReplyDeleteThis matter is a very difficult one to address with a strong sense of conclusiveness. There doesn't seem to be an answer that is completely cut-and-dry that will sit well with all parties. Given that, I'd like to attempt to approach the matter as objectively as possible. Seeing that the patient is, at least, legally competent, yet still refuses to nourish themselves and also having no desire to be deceased, it may therefore be concluded that the unwillingness to nourish oneself and knowing the outcome is psychosis. In this light we should administer treatment which include a feeding tube, or IV, prescribe an anti-psychotic such as a mid to high dosage of Seroquel or the like, and begin intense phychothrerpy until the optimal body mass index is reached. Once this is established the patient should be released from the hospital's care under a counseling plan to include both one-on-one, group therapy, and psychotherapeutic medication.
As in any case when a patient is a threat to themselves, immediate or otherwise, it is the responsibility as of the care facility to administer treatment that will bring the patient out of harm's way and get them stable again. The patient may refuse treatment, in this case, nourishment, but refusing treatment when the mind is unsound is very typical in patients with psychosis and otherwise psychotic behaviors that inflict self harm. Starvation results in cognitive distortions and cognitive impairment and is common among anorexia patients. Not to mention body dysmorphic disorder which is often exhibited in these patients and leads to long-term patterns of self punishment. Hopefully through psychotherapy, behavior modification and medication the patient with recover from the disorder. Allowing the patient to destroy themselves would be negligence.
David B
DeleteI don't think that it would be negligence, doctors can't force someone who doesn't want to eat, to eat. going into the realm of implied and informed consent, those that can still make the choices know what they are getting themselves into and can choose to either get over it or be sucked into it. In our society, medications are the proverbial silver bullet to everything and when a person spends too much time on it, they can develop a tolerance to it.
Only when person is so compromised (to the point of coma), the idea of a feeding tube is feasable, though it may be against the wishes of the sufferer (especially if the person is under 18), doctors are compelled by the hippocratic oath to "do no harm" and will do what they can with the consent of the families, spouses, etc.
Though there can be a multitude of solutions and that many more problems that may arise out of force feeding someone, it can't be forced upon someone who still has the ability to think for themselves.
Jennifer T.
DeleteA.N. is a devastating psychological disease, with no real “cure”. Every human being has a different brain, chemical makeup, and drive which makes it tremendously difficult for a physician and psychiatrist to treat those with A.N. There is no “set” way to help these individuals and obviously if they have been battling their disease for years or even decades all of our pursuits have been in vain and totally ineffective. When a patient’s brain tells them they are fat, even at 45 pounds, what magic phrase will make them think differently? However since their lack of nutrition will hinder their thought process, it only seems right and decent to deliver their nutrition even if it means forcefully. These individuals cannot chose for themselves and discern what is logical and right for their health and be able to separate what their disease is telling them. They hear voices (in a way) that tell them they are fat, why would we support a psychological break and let them die? With other psych patients, under different diagnosis, we would never allow them to starve to death. We would medicate and keep them fed, at all costs. Why is this any different? Their psychosis is different and unexplored but it is still a mental illness in which the patient needs an intervention.
I believe the humane thing to do is to force feed these people for 2 weeks or until their labs show that their nutrition has risen to a normal standard. While this is happening this person should have psychiatrists working with them under very intense therapy, trying to break their self-image and what is acceptable in eating and what the correct weight should be for a person with their bone structure and height. If they still refuse to eat even after all of that we need to switch gears and try a new tactic, but we don’t give up on them. If their weight starts to fall again then force feeding begins again and our efforts double, but we should never just give up or give in to their bizarre inner voice, their mental illness.
We should be trying to figure out what made this patient feel so out of control with the rest of their world that they feel the need to completely obsess about their food and weight. Let’s not just put a band aid on this person’s pain, someone needs to dig deep and get to the root of this problem and then maybe we could help alter their mind set.
No matter what the A.N. patient tells you while they are in the disease’s grip, chances are it’s just what you want to hear, they have no real plan to change. When an addict isn’t ready to give up the addiction and others are forcing an intervention, what happens? They might go along with the treatment for a while but as soon as they are released they jump back into destructive behavior, yet again.
This disease is intense and all-consuming for these poor individuals, they need help on every level even if that means forcing eating, drinking, vitamins, psychiatric care, drugs and whatever else we can throw at them. They are God’s creation and deserve everything that we can do to stop the behavior and illness in its tracks.
This is a mental disease, and starvation is not a viable option. If someone wanted to commit suicide, (obviously this person has a mental illness) would you give them access to a razor, make them comfortable and let them know that you would give them the pain meds they needed while all their life force drained from their body, while under your care?
Without intervention in A.N. patients, the docs are willing to give them pain meds and watch while their life force slowly dissolves away, while under their care…
Now who is the crazy one?
J.Hornesby
ReplyDeleteHey Marina, I first want to say thanks for picking my brain!
I don't think there is a sub treatment once a patient is considered severely anorexic. The care the patient is receiving thus far is working to an extent however the patients that have severe anorexia are aware of the possible outcomes of their disorder and don’t really wish to die, but they are refusing the nutrition it takes to prolong the inevitable. So I say keep them comfortable with a minimal amount of stress and/or pain while allowing nature to take its course. I feel all decision making should made by the family and/or patient because know one should have say over the next persons life when they are capable of making up their own mind. I don't think it would be fair for the decision to be made solely by the doctors w/o the consent of the family because in my opinion most doctors are desensitized and are only looking for answer to help with the next time something like this happen and I don't like the idea of the doctor having that much power over the life of others. Again thanks for picking my brain, I'm trying not to be selfish about my decision and think about it from the patients side and I know I wouldn't want a tube down my throat.
I agree with you as well about each case being different so there will never be one right answer, however what the patient and family see fit should be rule #1 when concluding on the next step. What universal code of conduct if any do you think doctors should take? Would you still feel as strongly about your choose not to force feed if the patient was a family member or close friend?
testing
ReplyDeleteAnita M.
ReplyDeleteSo I feel that this is a very severe psychological disease and should be treated as such. I feel that if people are sane they should be able to decide whether or not they want to undergo treatment it should be their decision. If the treatment process is a very hard ongoing process they have the right to refuse we do have the right to live but if it will be a poor quality life they have the right to refuse treatment because living in a hospital and being unhappy is not living at all. Sometimes people are sick past the point where the time energy or resources would be a wast of time and money. Especially if it is for someone to feel better about themselves and say that they tried everything possible. I feel like the person and their family should be able to make the decision as to if the time and effort would be worth while.