title: Medical futility and psychiatry: palliative care and hospice care as a last resort in the treatment of refractory anorexia nervosa.
abstract: OBJECTIVE
  The concept of medical futility is accepted in general medicine, yet little attention has been paid to its application in psychiatry. We explore how medical futility and principles of palliation may contribute to the management of treatment refractory anorexia nervosa.
  
  
  METHODS
  We review the case of a 30-year-old woman with chronic anorexia nervosa, treated unsuccessfully for several years.
  
  
  RESULTS
  Ongoing assessment, including ethical consultation, determined that further active treatment was unlikely to resolve her condition. The patient was referred for palliative care and hospice care, and ultimately died.
  
  
  CONCLUSIONS
  Although circumstances requiring its use are rare, palliative care may play a role in the treatment of long suffering, treatment refractory patients. For poor prognosis patients who are unresponsive to competent treatment, continue to decline physiologically and psychologically, and appear to face an inexorably terminal course, palliative care and hospice may be a humane alternative.
authors.affiliation: Department of Psychiatry, University of Colorado, Denver, Colorado, USA. amy.lopez@uch.edu
authors.forename: Amy
authors.initials: A
authors.lastname: Lopez
authors.forename: Joel
authors.initials: J
authors.lastname: Yager
authors.forename: Robert E
authors.initials: RE
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy*; D015992:Body Mass Index; D002908:Chronic Disease / Q000523:psychology; D003120:Colorado; D004992:Ethics, Medical; D015444:Exercise / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000941:ethics / Q000523:psychology*; D006801:Humans; D018447:Medical Futility / Q000941:ethics / Q000523:psychology*; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000941:ethics / Q000523:psychology*; D010348:Patient Care Team; D012017:Referral and Consultation / Q000941:ethics; D016312:Treatment Refusal / Q000941:ethics / Q000523:psychology