Food Refusal, Anorexia and Soft Paternalism: What's at Stake?
Abstract
Anorexia nervosa, or restrictive anorexia, is one of a collection of disorders that includes bulimia and binging and purging syndromes. Because it is common (it is the second most common disorder diagnosed in adolescent girls, for example); hard to treat; and sometimes fatal, anorexia raises urgent ethical and societal concerns. When adequate and perhaps lifesaving nutrition is refused by the patient, do others have a right or even a duty to impose it through feeding tube or IV nutrition? Procedures such as these that can be compelled, or coerced, if necessary by force, are the primary focus in what follows.
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The assessment of (in)capacity and use of coercion and involuntary treatment in AN is fraught with conflicting values and ethical questions of human rights.
“The assessment of (in)capacity and use of coercion and involuntary treatment in AN is fraught with conflicting values and ethical questions of human rights [151–153].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [151]
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“This is particularly concerning given the fact that anorexic patients are regularly deemed to possess decisional capacity and are competent according to the relevant legal and clinical standards in both the U.S. and the U.K. (Radden 2021, Tan et al. 2007).”
InfluentialStarving to death and the anorexic frame of mind
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“At least until its very final stages, it is ostensibly reversible by the seemingly simple expedient of eating (for discussion of the implication of this anomalous feature, see Giordano, 2019; Radden, 2021a, 2021b).”
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“To add to these concerns, the youth and gender makeup of this patient population makes them particularly vulnerable to informal coercion and psychiatric paternalism (Radden 2021, Evans 2025), which again distinguishes this case from that of Parkinson’s.”
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Self-citationEthical issues related to restrictive practices for anorexia nervosa in young people
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“The reviewed literature introduces the idea that severe AN impairs capacity [17], which may prevent the young person from being able to make autonomous decisions [27–29].”
Influential
- Authors
- Radden, J. H.
- Corresponding author
- Radden, Jennifer H.
- ORCID
- Radden, Jennifer H.
- Venue
- Philosophy, Psychiatry, & Psychology
- Publisher
- Project MUSE
- Published
- 2021
- Volume
- 28
- Issue
- 2
- Pages
- 141-150
- ISSN
- 1071-6076 (ISSN-L)
- 1086-3303
- OpenAlex
- W3170972075
- Cited by
- 26
- References
- 0
- Citations by year
- 2026: 2 · 2025: 18 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Philosophy, psychiatry & psychology (publishedVersion)
- Project Muse (Johns Hopkins University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- anorexia nervosa, food refusal, paternalism, soft paternalism, medical paternalism, feeding tube, parenteral nutrition, coercion, patient autonomy, bulimia nervosa, adolescent girls
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