Background: Amelda is a 21-year-old female with anorexia nervosa admitted a total of 15 times over the previous threes to the hospital emergency room for symptoms of her disease. All traditional treatments by doctors thus far have failed. Amelda continues to view herself as overweight and rejects solid food and nutrients. She has gone to extreme measures, such as withdrawing supplements from her stomach using a syringe, to avoid gaining weight. Doctors have determined that the only effective way to stop these behaviors is through physical restraints and force-feeding using a naso-gastric tube. She exhibits depression and doctors declared her incompetent during all of her previous hospital visits.
Doctors and family members are considering withdrawing force-feeding although doing so may allow Amelda’s weight to drop to an even more dangerous level. Past incidents have shown that when Amelda’s weigh falls below 77 pounds, her vital signs drop to potentially fatal levels. Amelda has not exhibited any signs that she wishes to die. The primary moral dilemma here is whether or not to withdraw force-feeding under the principles of beneficence, non-maleficence, and autonomy. We previously debated this dilemma in class, so instead I will examine it in light of Beauchamp and Childress’s frameworks for surrogate decision-making and quality of life analyses.
Discussion: In my personal analysis of Amelda’s case, I supported the classification of Amelda as incompetent and the passing of informed consent on to her parents. Beauchamp and Childress present here standards for surrogate consent generally recognized in bioethics: substituted judgment, pure autonomy, and the patient’s best interests (226). Amelda’s parents could adopt their role (assuming it is morally and logically justifiable that Amelda is incompetent) under any of the three standards, however the patient’s best interests standard is the most fitting. According to Beauchamp and Childress, both the substituted judgment and pure autonomy standards require some form of previous knowledge of the patient’s wishes and values or official directives issued by the patient before they entered an incompetent state. Amelda is 21 and we know she has received medical care for anorexia for the past three years, but we don’t know if this the start of these three years marks the start of her symptoms that impaired her moral status and competence.
While it’s logical to assume that Amelda has not suffered from anorexia for her whole life (most new incidences of anorexia are in teens)(“Anorexia Nervosa”), we do not know whether or not she had other health issues that impaired her competence. Even assuming that Amelda’s disease began when she started treatment would put her age at the start of her illness at 18. She would have just entered into legal adulthood, making it unlikely that she had previously expressed any mature values or wishes about her health preferences that her parents could draw on in the present case. Therefore, the patient’s best interest standard seems the most ideal choice for Amelda’s parents to operate under because it does not require considerations of a patient’s previous opinions. Because of the key component of the case that states that Amelda does not express any interest in death, it seems in the patient’s best interests to take all measures necessary to preserve her life. Weighing the costs and benefits of Amelda’s options, preserving Amelda’s life with (hopefully) temporary force-feeding and continuing psychiatric treatment in a chronic care facility outweighs the risk of her sustaining psychological and emotional damage from her position of being physically restrained based on her want to live (even if it is expressed with a distorted view of survival).
Works Cited
“Anorexia Nervosa | National Eating Disorders Association.” Anorexia Nervosa | National Eating Disorders Association. N.p., n.d. Web. 1 Apr. 2015. <https://www.nationaleatingdisorders.org/anorexia-nervosa>.
Childress, James F. “Beneficence.” Principles of Biomedical Ethics. By Tom L. Beauchamp. 7th ed. New York: Oxford UP, 2013. 226-41. Print.
Wiegert, Carolyn. Exam 1: Morality and an Extreme Case of Anorexia Nervosa. N.p.: n.p., 14 Mar. 2015. PDF.
This case is extremely tricky. However, I have also slightly changed my viewpoint on the case from the past week of class discussions compared to when I wrote my essay. At the end of the day, I think it comes down to Amelda’s competence level. Considering she is deemed incompetent, the decision should be passed to her parents. She has said she doesn’t want to die, and her parents also don’t want her to die, so they should continue treatment to do so. The biggest issue here arises when we consider the terms beneficence and nonmaleficence. While we should do no harm and act to help, it is challenging because continuing to keep Amelda alive comes with harms to her body, such as self restraint. I can definitely see how each side can be argued, and that’s why I almost feel like the more we learn, the more I constantly leave this case feeling puzzled about the right answer.
I agree that this particular case regarding Amelda and the decision whether or not to continue forced-feeding treatment presents us with an extremely difficult choice, and this difficulty stems from the principles of beneficence and nonmaleficence, as Brooke mentioned. I don’t believe that there is any doubt that Amelda should be considered incompetent; the clearest evidence perhaps being the act of her taking extreme measures to withdraw nutrients from her body. There is certainly no consideration by Amelda of the possible outcomes and we know that because the patient has not expressed a desire to die. For this reason I think it is necessary for the patient’s parents to be the ones who ultimately make the decision. Of course, assuming the parents would be deciding in Amelda’s best interest, this is the most reasonable option since the parents would be the most likely to know what exactly Amelda would desire if she were not in an incompetent state. My problem with this is that either way, the parents’ decision could be viewed as malign. If they allow their daughter to deny treatment and pass away, their actions could be considered negligent; if they agree to continue forcefully administering treatment to her, their actions could be considered negligent as well. So even though it seems that leaving the decision to be made by the surrogates is the most appropriate course of action, does it really solve any problem? The parents are faced with making a decision for their daughter, which either way you could argue would be disapproved by Amelda herself.