June 16, 2012

It's not force feeding, but it may be too late

My problem with a judge compelling a dying anorexia patient to be fed is not the action but the timing. This patient and her family had, it seems, accepted her coming death. She was in palliative care after suffering years of anguish. Why do we wait until this happens?

Why do we consider patients to be "choosing" not to eat unless they are already gravely medically ill? Were the decisions more reasonable early on? Is a choice to starve yourself a bit, but not too much?

I believe patients should never be "force fed" any more than they are "force revived" when drowning. The problem is that we're not recognizing anosognosia and we think that food is somehow optional and don't see that the inability to eat is NOT A CHOICE.

Yes, I know this is what you are thinking. But is is not.
People with an eating disorder predisposition often lose their ability to think clearly when they are undernourished. Think of it as temporary partial blindness.

I've talked to plenty of former patients who are grateful that their family and clinicians did what needed to be done even when they were saying "I can't" and "I don't want to" and "I'd rather die."

Lack of insight and motivation are known symptoms of malnourishment. Without restoring a patient to normal brain function and waiting for brain repair we simply don't know what that person's real and lasting desires are. The evidence from people who have survived suicide attempts also bears notice: they most often regret their actions and want to live.

THIS is how I think of making sure anyone with an eating disorder history
 is getting 100% of the nourishment they need in a safe, protective
 environment. Eating every meal is no less urgent that breathing every breath.
Our job is to help those in despair, get them well and keep them safe - not to torture them by leaving them without treatment and support until they are nearly gone, and revive them only to start the process again.

It's not force feeding. And it shouldn't wait. Every meal, every day is essential to mental health for ED patients. If they can't, it's our job and it is US who have failed - not the patient. Our customs, our laws, treatment availability, and our thinking HAVE to change. We are torturing and killing these patients.

2 comments:

  1. Isn't it frightening from a parental perspective to see this process evolving so clearly in front of your eyes and most of the medical and psychiatric field of professionals don't? I think that if I hadn't learned early on from my profession as a ER nurse, that having the title of physician does not ensure adequate or even sometimes competent treatment and care, my daughter could be suffering the same end result. I'm not speaking for all because I have met and worked with excellent physicians and the difference is crystal clear.
    My daughter and our family were lucky enough to find Drs O'Toole and Moshtael and the Kartini team who took the very necessary action of having a G-tube placed to save my daughter life. It was not a quick or easy decision but a necessary one. Without it, my daughter would have surely continued her physical and mental descent. She was not near death when the decision was made and I don't think there is another physician in this country who would have done the same thing. The critera to treat this illness is so piss poor, it may be by the grace of love and luck that many more don't die.
    It just shouldn't happen this way with the knowledge we have available to us. I know it continues to evolve but the treatment field is unacceptably too far behind the current knowledge.
    Btw, my daughter is healing, surviving and working together with her team and family towards a rich productive happy life! Something she and we want dearly

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  2. I distinctly remember resigning myself to the fact that there was nothing I could do - I was going to die. I didn't want to die, I just couldn't see there was anything I could do to prevent it. I have a wonderful life and a gorgeous family but I needed help to return to the world - I couldn't do it for myself. I understand this woman's resignation to die, but it saddens me greatly that everyone around her has given up on her to. I applaud this judge for making this decision.

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