A report in the National Post this week that detailed the treatment of a patient suffering from acute anorexia in a Vancouver hospital has one of the province’s senior health officials concerned that others in urgent need of care may now be too frightened to seek help.
“Eating disorders have a lot of stigma,” notes Dr. Julia Raudzus, medical director of B.C.’s adult tertiary eating disorder program at St. Paul’s Hospital. “And there is a lot of fear, even within the community of health professionals, around how to treat eating disorders. If someone is influenced by further fear that treatment is somehow scary or punishing, that may influence them to not seek treatment.”
Lenore Turton told the National Post that doctors at St. Paul's hospital called security, stripped her and locked her up after she panicked and tried to leave the hospital when a nasal gastric tube was being fitted. Turton reportedly came to the hospital for treatment voluntarily. "I came to the hospital voluntarily, seeking treatment, but I wasn’t offered any. Instead, I was detained with all my rights taken from me," she said.
Although unable to comment on Ms. Turton’s situation specifically, for reasons of confidentiality, Dr. Raudzus says that even when a patient with an eating disorder expresses the desire to live, the disease can sabotage their ability to change their behaviour in order to match that desire.
“An eating disorder is a mental illness,” she explains. “It is a complex psychiatric illness that confers the highest level of morbidity and death.”
In cases where someone with an eating disorder is in imminent risk of death, acute hospitalization is required, Raudzus says, and in order to stabilize their physical condition, constant feeding through a nasal gastric tube is necessary.
In less acute situations a care plan is worked out with the patient and goals are set to help them reach a physical state that allows them to leave hospital. The difficulty comes when the individual is in grave physical danger and is unable to appreciate the severity of their situation.
“We recognize that an acute hospital admission is not a great way to do all of the psychological work, but it is a great place to save someone’s life.
“If someone is really sick, it doesn’t matter how ready they are for treatment, they need medical intervention in order to live.”
How able a patient is to understand their situation and make informed consent about treatment is an ethical dilemma medics face all the time, says Anita Ho, associate professor at UBC’s Centre for Applied Ethics and director of ethics services for Providence Health Care. Though St. Paul’s is part of Providence, Ho was not involved in Turton’s case.
“If a patient has the capacity to make a decision about their treatment, usually they have the right to do so,” she says.
In an urgent life-saving situation with a cognizant patient, the law actually requires consent, she explains. “The usual example given here is that of a Jehovah’s Witness who refuses a blood transfusion knowing that decision will result in death.”
In a situation where a patient is suffering from a psychological disorder and is considered to be posing an immediate health risk to themselves or others, the Mental Health Act may be invoked to commit that person to care. This may involve the use of restraints, either physical or chemical (anti-psychotics), but does not automatically mean their physical illness may be treated unless the patient’s lack of ability to make a reasonable decision about it would lead to their death.
“For example, someone presents believing themselves to be God and wants to fly out of the window, then no, we can’t allow that,” she says.
The issue for medical professionals is to ask whether the patient will be happy to have their life saved in the long term.
“We would have no suicide prevention at all if we decided to take a depressed person’s word that they would be better off dead,” she notes.
Turton told the National Post that she is now home and eating solid food again. She is getting married in two weeks.