Eating disorder clinicians are guided by ethics to ensure the best for every patient that comes into their care. In general, ethics help clinicians determine appropriate clinical decisions and behavior. They provide a compass for what is “right” and what is “wrong,” although determining that is not usually so simple. Treatment providers will encounter a variety of moral dilemmas in their careers, and ethics can provide a general framework for navigating these situations.
In this blog, we will cover key ethical principles in the treatment of eating disorders, as well as several dilemmas that the field’s clinicians may face.
Ethical Principles in Eating Disorder Treatment
When a person’s work involves caring for the health and wellbeing of others, ethical principles need to be considered regularly. Just like eating disorders themselves, the ethics in the treatment of these illnesses is complex. Eating disorders treatment requires a multidisciplinary team including registered dietitians, therapists, medical providers, and psychiatrists. Depending on a provider’s specific profession and scope of work, ethical principles and standards can vary.
The following are examples of the ethical principles commonly used in the field of eating disorder treatment:
- Autonomy: giving the patient the freedom to choose, where that is possible
- Beneficence: taking actions or giving recommendations that are in the best interest of the patient
- Confidentiality: protecting a patient’s private information and sharing that information responsibly
- Informed consent: ensuring that a patient has all the information they need in order to give full consent
- Duty to protect: protecting patients from harming themselves or others
- Justice: making decisions for the patient that are fair and equitable
- Paternalism: choosing a course of action without the patient’s consent but in their best interest
- Integrity: adhering to a moral code that includes honesty and truthfulness
Potential Ethical Dilemmas in Eating Disorder Treatment
Even with the guidance of ethical principles, the treatment of eating disorders is complex. Clinicians will most likely find themselves dealing with conflicting principles, which can make it challenging to decide the best course of action. Learn about several different kinds of ethical dilemmas that arise in eating disorder treatment below:
Resistance to treatment
A patient’s resistance to treatment is often reinforced by the eating disorder itself. Discussing the patient’s reasons for wanting to change and pursue recovery can be helpful in reminding them why they reached out for help in the first place. Resistance to treatment is normal and understandable. Seeking help often comes with concerns about facing social stigma for their illness, fear of letting go of their eating disorder, anxieties about possible weight changes, and more.
The power of the therapeutic relationship
The relationship between a patient and a therapist is essential to aligning eating disorder treatment goals and recommendations. If the patient values their relationship with their therapist, they are more inclined to heed their advice in eating disorder treatment, particularly when pursuing higher levels of care. Therapists must be careful to not abuse the influence they may have over their patients.
Involuntary treatment involves treating someone against their will for the purpose of their safety. For obvious reasons, this concept comes with various ethical dilemmas. Providers must take into account the patient’s illness history, the severity of their eating disorder symptoms, and their general psychiatric state. There are very rare cases when someone may need to be forced into treatment for their own safety.
Treating at a lower level of care than is clinically recommended
There are instances where the patient or the patient’s family does not want to enter the level of care recommended by their treatment team. They could be concerned about other life responsibilities or simply believe that they can take care of the illness on their own. Ethically, providers must respect patient choices while also ensuring that they have all the information they need to make an informed decision.
Everyone, including eating disorder treatment providers, has biases and different subject areas in which we are not experts. Individuals working in healthcare can ensure that they are held accountable for examining these biases by participating in ongoing supervision and consultation, regardless of their years of experience. Getting this support is not shameful; it demonstrates a person’s dedication to their patients and the quality of their work.
Considering personal experience
It is common for eating disorder treatment providers to feel pulled to the profession because they have experienced the illness themselves and want to help others through it. If a provider is in recovery or recovered from an eating disorder themself, they need to be sure to protect their own recovery while they help others. Ongoing supervision, as well as setting and maintaining boundaries, is essential to protecting a provider’s personal health and boundaries.
Considering ethical principles in the treatment of eating disorders is essential to providing quality care that is built on empathy, competence, and integrity.
If you work with patients with eating disorders, please consider attending “Ethical Considerations in the Treatment of Eating Disorders,” a webinar presentation from Krista Crotty, LMFT, PsyD, on Thursday, May 9th.