Forced treatment of anorexic patients: part 2.
OBJECTIVE
The purpose of this review was to update and complement part 1 of this study. Clinical, ethical and legal approaches to forced treatment in patients with anorexia nervosa were considered in the light of recent literature.


RESULTS
The first comparison of compulsorily detained adolescents and those treated under parental consent shows mainly advantages in the short and medium term of using the Mental Health Act. In a qualitative study, a pathway for advance decisions has been developed. Implications of the Human Rights Act for clinical practice have been elucidated. A case report of a pregnant anorexic woman shows the risk for her foetus. The ethical dilemma of treating a woman with cerebral palsy and chronic anorexia nervosa has been reported and an ethical re-evaluation of treatments for (especially chronic) anorexia nervosa recommended.


CONCLUSIONS
The treatment of adolescents with severe anorexia nervosa may be improved by detention under the Mental Health Act. The Human Rights Act has implications for the treatment of anorexia nervosa. Guidelines for treating anorexia nervosa should include recommendations for pregnant sufferers as well as for those with severe physical comorbidity. A shift from cure to care for chronic anorexia nervosa might improve ethical conduct.
Thiels
Cornelia
C
Department of Social Studies, University of Applied Sciences Bielefeld, Bielefeld, Germany. cornelia.thiels@fh-bielefeld.de
Curtice
Martin
M
D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000628:therapy*; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D005060:Europe; D005260:Female; D005555:Forensic Psychiatry / Q000941:ethics* / Q000331:legislation & jurisprudence*; D006801:Humans; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D011247:Pregnancy