Ethics and involuntary treatment for Anorexia Nervosa in context: a social work approach

Abstract

The ethics debate in the literature on involuntary treatment for anorexia nervosa (AN) is underpinned by biomedical ethics approaches. Biomedical ethics assigns expert status to professionals to objectively balance ethical principles in patients best interests. The debate is centred on the issue of how to respect the autonomy of patients with AN who refuse treatment whilst protecting them from harm. However, in practice, decision making about the ethics of involuntary treatment for AN occurs in a multidisciplinary context. Thus, it is surprising that there are no non-biomedical contributions to the debate. The aim of this research is to address this limitation by making a social work contribution.

Social work ethics is compatible with biomedical ethics. However, social work ethics emphasises professional responsibility for promoting client empowerment, participation, and self-determination. Yet, similarly to biomedical ethics principles, social work values are presented as one-dimensional and objective. This obscures the complexity of conceptualising and applying professional values in practice (with persons with AN who refuse treatment). Further, this bypasses the issue that the interpretation of professional values and principles occurs in the context of team dynamics where particular discourses of professionalism and good practice operate. These discourses affirm particular knowledge and values.

Taking a social work approach, it is imperative to reveal the moral dimension of practice and how professional discourses and practice can be disempowering for patients. In order to make this social work contribution to the debate a postmodern ethics approach has been applied. This approach promotes professional moral responsibility for (the hegemony of) professional knowledge. Consistent with this approach, an ethnographic study in the involuntary treatment environment was also conducted. This involved observation of eating disorders team meetings, in-depth interviewing with professionals and a case-study of a former involuntary patient.

The findings of this study highlight the moral relevance of examining the construction of professional knowledge in context. This illuminates the authority and fallibility of professional knowledge. In turn, patient knowledge is crucial for the ethics of involuntary treatment so that professional practice is not inherently paternalistic and professional knowledge and values are not taken for granted.