Medical futility and psychiatry: Palliative care and hospice care as a last resort in the treatment of refractory anorexia nervosa
Open accessAbstract
OBJECTIVE: The concept of medical futility is accepted in general medicine, yet little attention has been paid to its application in psychiatry. We explore how medical futility and principles of palliation may contribute to the management of treatment refractory anorexia nervosa. METHOD: We review the case of a 30-year-old woman with chronic anorexia nervosa, treated unsuccessfully for several years. RESULTS: Ongoing assessment, including ethical consultation, determined that further active treatment was unlikely to resolve her condition. The patient was referred for palliative care and hospice care, and ultimately died. DISCUSSION: Although circumstances requiring its use are rare, palliative care may play a role in the treatment of long suffering, treatment refractory patients. For poor prognosis patients who are unresponsive to competent treatment, continue to decline physiologically and psychologically, and appear to face an inexorably terminal course, palliative care and hospice may be a humane alternative.
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Terms such as 'treatment resistant', 'treatment refractory', 'recalcitrant', and 'severe and intractable' have appeared frequently in eating disorder research and commentaries, often within sweeping statements suggesting patients who have not recovered within a number of years are unlikely to improve with further treatment.
“Terms such as “treatment resistant” (120 p. 247), “treatment refractory” (121 p. 372), “recalcitrant” (122), and “severe and intractable” (123) have appeared frequently in ED research and commentaries, often within sweeping statements suggesting patients who have not recovered within a number of years are unlikely to improve with further treatment.”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [121]
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References 19 · Cited by 97
- Authors
- Lopez, A., Yager, J., & Feinstein, R. E.
- Affiliations
- University of Colorado Hospital (US)
- University of Colorado Denver (US)
- Corresponding author
- Lopez, Amy
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2009-05-14
- Volume
- 43
- Issue
- 4
- Pages
- 372-377
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2128374535
- Cited by
- 97
- References
- 19
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 9 · 2023: 9 · 2022: 10 · 2021: 5 · 2020: 24 · 2019: 5 · 2018: 1 · 2017: 2 · 2016: 9 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- futility, palliative care, hospice care, chronic anorexia nervosa, ethics consultation, end-of-life care, terminal illness, prognostic assessment
- MeSH terms
- Adult, Anorexia Nervosa, Chronic Disease, Colorado, Ethics, Medical, Female, Humans, Obsessive-Compulsive Disorder, Palliative Care, Patient Care Team, Referral and Consultation, Exercise, Body Mass Index, Treatment Refusal, Hospice Care, Medical Futility
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