Presuming incapacity in anorexia nervosa is indefensible: A reply to Ip
Abstract
Eric C. Ip has recently argued that seriously anorexic service users ought to be assumed to be legally incapacitous to refuse life‐saving artificial nutrition unless they can demonstrate otherwise, reversing the ordinary legal presumption in place to protect patients’ liberty and values. In this response, I argue against this proposal on two grounds. Firstly, the proposal is wrongfully discriminatory; it would expose service users to serious harm, and wrong them in numerous ways, on the basis of their diagnosis alone, without significantly benefitting them in any way relative to the status quo. Secondly, he is unable to show that a large majority of such service users actually are incapacitous to refuse life‐saving artificial nutrition. This means that his proposal would likely involve declaring a large number of actually capacitous patients to be incapacitous, without even the requirement of a formal assessment, and burdening them with the responsibility of proving their clinical team wrong if they wish to avoid deprivation of liberty and/or compelled treatment. Given this, his proposal is indefensible.
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We and others take issue with the sweeping assertion that patients with anorexia nervosa lack capacity for medical decision-making.
“We and others (e.g. [28, 29]), take issue with the sweeping assertion that patients with AN lack capacity for medical decision-making.”
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Westermair, A. L., Weber, S., Westmoreland, P., Mehler, P. S., Elsner, F., & Trachsel, M. (2024) · Annals of Palliative Medicine · doi:10.21037/apm-23-522 · Cited by 15 · see citing works
Ethical Challenges in the Treatment of Patients With Severe Anorexia Nervosa
Westmoreland, P., Yager, J., Treem, J., & Mehler, P. S. (2024) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20230035 · Cited by 7 · see citing works
Bioethical aspects in the approach to anorexia nervosa
Mota, J. A. C., do Amaral, T. M., & Tôrres, H. O. D. G. (2025) · Revista Bioética · doi:10.1590/1983-803420253860en
Aspectos bioéticos envolvidos na abordagem da anorexia nervosa
Mota, J. A. C., do Amaral, T. M., & Tôrres, H. O. D. G. (2025) · Revista Bioética · doi:10.1590/1983-803420253860pt
Aspectos bioéticos involucrados en el abordaje de la anorexia nerviosa
Mota, J. A. C., do Amaral, T. M., & Tôrres, H. O. D. G. (2025) · Revista Bioética · doi:10.1590/1983-803420253860es
End-of-Life Care bei Anorexia nervosa
Westermair, A. L. (2025) · Die Psychotherapie · doi:10.1007/s00278-025-00785-2
“Andere Autor:innen vertei-digen den fähigkeitenbasierten Ansatz, da eine diagnosebasierte Abweichung vom Standard diskriminierend wäre (Miller Tate 2021).”
Turner, L. M., Hughes, A. C. M., Lakhani, J., Katzman, D. K., & McCradden, M. D. (2026) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2026.102232
- Authors
- Miller Tate, A. J.
- Affiliations
- Centre of Medical Law & Ethics Department of Philosophy King’s College London London United Kingdom of Great Britain and Northern Ireland
- Venue
- Bioethics
- Publisher
- Wiley
- Published
- 2021-04-23
- Volume
- 35
- Issue
- 6
- Pages
- 596-601
- ISSN
- 0269-9702 (ISSN-L)
- 1467-8519
- OpenAlex
- W3156954089
- Cited by
- 8
- References
- 0
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2022: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bioethics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- anorexia nervosa, legal incapacity, artificial nutrition, withholding treatment, patient autonomy, deprivation of liberty, involuntary treatment, discriminatory treatment, capacity assessment
- MeSH terms
- Anorexia Nervosa, Humans, Male, Treatment Refusal
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