Should We Allow Patients with Eating Disorders to Die? Ethical Considerations and the Debate over Terminal Anorexia Nervosa: A Bioethics SIG-Sponsored Symposium

Abstract: In January of 2024, the New York Times Magazine published an article entitled Should patients be allowed to die from anorexia? (Engelhart). The article explores the concepts of terminal eating disorders, and suggests a possible extension of these concepts to other psychiatric diagnoses such as major depression. The article also discusses the emerging field of palliative care psychiatry. Terminal anorexia nervosa has stimulated considerable controversy in the professional literature for nearly 25-years; however, with this article, Engelhart has brought the topic into the public arena, sparking the interest of our colleagues and patients. We have a duty as consultation-liaison psychiatrists to be informed and thoughtful in approaching this topic so that we can bring to these often distressing conversations not only our medical knowledge and experience but also our ethical training and expertise.



Among the most crucial aspects of the debate is definitional. Is what is clinically known as ‘severe and enduring anorexia nervosa’ in fact, ‘terminal anorexia nervosa?’ Attempts to answer this question have been fraught with challenges. Gaudiani and colleagues proposed a definition in their 2022 article in the Journal of Eating Disorders. Eddy and colleagues, however, point out that even patients who have struggled with anorexia nervosa for decades may still recover. (2017). More broadly, the idea of palliative psychiatry uses the philosophy of a focus on quality of life to apply to those suffering from treatment-resistant psychiatric conditions yet is still in search of consensus definition (Trachsel 2016). The integration of palliative medicine with psychiatry presents new grounds for caring for the whole patient.

10 minutes - Dr. Anita Chang will discuss the New York Times article and provide an illustrative case of terminal anorexia nervosa.

15 minutes - Dr. Shannon Mazur will present a case of terminal anorexia nervosa in the setting of a cancer diagnosis and discuss the concept of capacity in situations as complex as this.

15 minutes - Dr. Emily Holmes will discuss the potential harms of labeling psychiatric disorders as terminal and provide an illustrative case.

15 minutes - Dr. Diana Punko will discuss the application of palliative medicine practice to psychiatry as well as the concept of palliative psychiatry.

20 minutes - We will conclude with a large group discussion of the topics above with a question and answer session.