تغییر تراز: معضلات اخلاقی و قانونی در مدیریت اختلالات شدید خوردن

"Unlike patients with other mental health disorders, such as schizophrenia or bipolar illness, for whom a medical physician rarely needs to be involved in care delivery, patients with eating disorders have a litany of significant medical complications that demand close oversight by a medical doctor knowledgeable in treating these disorders. However, prior to the 1980s, little available literature elucidated the best medical practices for these patients, and currently, very few physicians have much medical expertise in this specialized area. This is disconcerting, because these patients are known to be frequent utilizers of the medical system who are often admitted to hospitals and emergency departments for medical complications of their disorders. In addition, anorexia nervosa has the highest mortality rate of any mental disorder except opioid abuse, and the standardized mortality ratio for bulimia nervosa is almost twice that seen in age-matched control subjects. Moreover, much of the excessive mortality rate in AN is attributable to medical complications. Thus, there is an impelling need for this book, which highlights the medicolegal and ethical challenges in treating individuals with EDs. Progress in the medical and psychological treatment of eating disorders over the past half-century has shown us what we can do but sometimes leaves unanswered questions about what we should do in difficult situations, such as the case of a person with a severe and enduring eating disorder who is symptomatic, resists treatment, and requires repeated involuntary hospitalizations. This book explores the ethical and legal dimensions of these difficult questions"-- Provided by publisher Tipping the Scales: Ethical and Legal Dilemmas in Managing Severe Eating Disorders centers on the complex and at times wrenching medicolegal and ethical challenges encountered in treating patients with severe and enduring eating disorders (SEEDs). Unlike other mental health disorders, for which the care of a medical physician is typically unnecessary, patients with eating disorders have many significant medical complications that demand careful oversight by a physician knowledgeable in treating these disorders. The tragic dearth of such expertise is made more alarming by the fact that anorexia nervosa has the highest mortality rate of any mental disorder aside from opioid abuse. Accordingly, the book addresses the medical consequences of SEEDs and explores that subgroup of patients whose illness appears intractable -- people who are no longer seeking a'cure'but, rather, enough improvement to afford them a reasonable quality of life. For such patients, depending on their age, treatment history, and support system, treatment teams may either commit to achieving a full recovery or engage in a harm reduction model. In empathic, accessible prose, the book • Examines ethical conflicts that arise in SEEDs, in particular the critical dilemma between saving a life and reducing suffering. Although both are core values of medicine -- and eating disorders have an exceedingly high mortality rate -- relief of suffering through refeeding and other treatments can bring about both physical and emotional discomfort. • Reviews the issues of patient autonomy and mental capacity in the question of who ultimately gets to establish treatment goals. The assignment and role of medical guardianship for patients deemed incapacitated is described in detail. • Explores the perception of'futility,'which may reflect burnout of the treatment team for these very challenging patients rather than no hope of success. In particular, perceived futility may contribute to the increased emergence of physician-assisted death and euthanasia in this population both internationally and in the United States. • Devotes several chapters to the differences between palliative care, harm reduction, and futility. Patients sometimes leave treatment and request palliative care, and the book addresses the role of psychiatry in such cases as well as advance care planning and other essential topics.• Describes the medical complexities and comorbidities inherent in caring for patients with SEEDs, including bone density loss, gastrointestinal complaints, and cardiac irregularities, which can result in death.• Presents numerous case studies for comparison, elucidating the thorny ethical and legal issues attendant upon caring for these patients. Tipping the Scales assists physicians, mental health professionals, and patients in making decisions that are in the patient's best interests, whether they lead to healing and recovery or a dignified passage within the bounds of our current knowledge and the ethics of palliative end-of life care. Treatment advances, both medical and psychological, have increased what can be done for patients with severe eating disorders, but answers to what should be done remain elusive. For this reason, Tipping the Scales: Ethical and Legal Dilemmas in Managing Severe Eating Disorders is a groundbreaking book, one that takes an unflinching look at the role of ethics in compelling treatment for individuals with severe and enduring eating disorders (SEEDs) and the legal context in which coercion, civil commitment, and related issues are situated. Although eating disorders have commanded a great deal of attention from the media, prior to the 1980s there was little published literature to elucidate best medical practices for patients with SEEDs, and currently very few physicians have much medical expertise in this specialized area. The editor, an expert in both eating disorders and forensic psychiatry, has convened a group of contributors who are similarly accomplished, and together, they explore ethical considerations, coercion in treatment, mental capacity in anorexia nervosa, medical guardianship, civil commitment, harm reduction, palliative care, end-stage anorexia, physician-assisted death, and more. These topics are complex, but essential, to consider, and the authors offer multiple case vignettes to help clinicians tease out the ethical issues and identify a clear path to care that is in patients' best interests. Tipping the Scales is unique in its fearless yet compassionate approach to managing the most treatment-resistant cases of eating disorders. Cover Halftitle Title Copyright Dedication Contents Contributors Introduction 1 Treatment of Eating Disorders: An Historical Perspective 2 Basic Principles of Ethics 3 Coercion in Treatment 4 Mental Capacity in Anorexia Nervosa 5 Role of Medical Guardianship 6 Civil Commitment 7 Severe Eating Disorders in Children and Adolescents: How Are Childhood Eating Disorders Different? 8 Novel Treatments for Patients With Severe and Enduring Eating Disorders 9 Harm Reduction 10 Eating Disorders and Palliative Care 11 Futility 12 Eating Disorders and Physician-Assisted Death Index A B C D E F G H I J K L M N O P Q R S T U V W Back Cover