Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined

Angela S Guarda; Annette Hanson; Philip Mehler; Patricia Westmoreland

doi:10.1186/s40337-022-00599-6

Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined

J Eat Disord. 2022 Jun 7;10(1):79. doi: 10.1186/s40337-022-00599-6.

Authors

Angela S Guarda¹, Annette Hanson², Philip Mehler³, Patricia Westmoreland⁴

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA. aguarda@jhmi.edu.
² Department of Psychiatry, University of Maryland, Jessup, MD, 20794, USA.
³ Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁴ Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, 80045, USA.

Abstract

A recent article (JED 10:23, 2022) proposed defining terminal anorexia to improve access to palliative and hospice care, and to medical aid in dying for a minority of patients with severe and enduring anorexia nervosa (SE-AN). The authors presented three cases and, for two, the first author participated in their death. Anorexia nervosa is a treatable psychiatric condition for which recovery may be uncertain. We are greatly concerned however regarding implications of applying the label "terminal" to anorexia nervosa and the risk it will lead to unjustified deaths in individuals whose mental illness impairs their capacity to make a reasoned treatment decision.

Keywords: Anorexia nervosa; Capacity; Competence; Involuntary treatment; Medical assistance in dying; Physician assisted death; Physician assisted suicide; Severe and enduring anorexia nervosa; Severe and enduring eating disorders; Terminal anorexia.

Publication types

Letter