Anorexia and Involuntary Hospitalization:
What if the “cure” is worse than the “illness”?

Chris Kraatz, Ph.D.
Senior Lecturer in Philosophy

Indiana University - Purdue University Indianapolis

Abstract

        A significant minority (approximately 15%) of patients hospitalized for anorexia nervosa
are hospitalized involuntarily.  Discussions about whether or not this practice is ethical have been focused almost entirely on the general issues of paternalism and protection from self harm.  While these issues are certainly relevant, I aim to take the discussion in a different direction that is more specific to eating disorders.

        Presumably, a defense of involuntary hospitalizations as legitimate and ethical would have to include some reference to empirical data which indicate a tangible benefit for anorexic patients.  No such data, however, exist.  Recent published research, however, strongly suggests that
involuntary hospitalization itself presents significant risks for anorexic patients that should not be ignored, the most disturbing of which is that involuntary patients have at least four times the mortality rate of their voluntary peers.  Based on these demonstrated risks, I argue that a moratorium on such involuntary hospitalizations is necessary.

        In light of these facts, the defining question inevitably becomes one of why a practice with such demonstrated risks and undemonstrated benefits, a track record which would not be permitted to continue in any other area of healthcare, would be so common and unquestioned in the field of eating disorders?  In response to this defining question, I propose consideration of two relevant and troubling observations:

• that the overwhelming majority of people in positions to decide whether or not anorexic
  patients will be involuntarily hospitalized (doctors and judges) are men while the
  overwhelming majority of people rendered powerless and put at risk by these decisions
  (anorexics) are women, and
• that the financial rewards for institutions providing in-patient treatment for anorexia
  are lucrative, averaging in excess of $47,000 per patient.