Resolving ethical issues faced by clinicians treating eating disorders

Diane Girardot is sending dispatches from the Renfrew Center Foundation's 22nd Annual Eating Disorder Conference this weekend.

by Diane R. Girardot

Did you know the word "should" denotes a conflict right from the start? Should I attend the next conference session about men and eating disorders or should I write this blog from today's morning session on decision making?

This is one of those dilemmas where there are two or more conflicting values - participation or productivity? If time (and energy) permitted I would devote myself to both independently. Unfortunately acting on one automatically violates the other.

Ruth Lipschutz, LCSW, a Chicago-based mental health professional who specializes in professional ethics, explained the "should" concept Friday at the Renfrew Foundation Eating Disorders Conference being held in Philadelphia this weekend.

She focused on resolving ethical and moral issues faced by clinicians treating eating disorders and on the process required to sort through the "shoulds" that arise during treatment.

What determines a sound mind? What do you do if a patient isn't working to get better? And, what happens when parents sabotage treatment?

While clinicians are trained to support a client's autonomy to make their own decisions, "should" they when it is against medical advice? What if a teen hospitalized on bed-rest with a below 70 percent body weight wants to leave the hospital and her parents want her home, do you let her go? If the parents take her, is that neglect? Should you involuntarily commit her?

"Capacity by federal and state law is defined as being competent to consent at that point in time," Lipschutz explained. Many eating disordered patients can make good decisions in every other aspect in the lives but have a distorted capacity regarding themselves.

Decision-making for people physiologically and biologically traumatized - as in grief - is impaired because frontal lobes aren't functioning as much as the emotion regulating parts of the brain. A malnourished brain struggles in much the same way except the whole brain is affected, she explained.

Lipschutz cited several philosophical models for consideration in decision making, including the popular "means justifies the end" and "intrinsic truths exist" models. But most of all, she said, ranking what you value is the first step.

Consider fairness - is there favoritism or discrimination? Or the common good - the individual needs weighed against the good of the community. Or virtue - ideals like humanity, honesty, courage, and integrity.

Lipschutz said a person's values, beliefs, and obligations can shift over time and with experience. They can also adapt to keep pace with rapidly changing social and cultural norms.

For example, she explained, it isn't unusual for an Orthodox Jewish home to reform strict practices once older parents are deceased. Or, you cave and get your 10-year-old a smart phone when you said she couldn't have one until she was 13.

Anyone faced with a moral or ethical dilemma "should" consult with supervisors, retain ethical and legal expertise and review their core values to better identify the exact conflict, Lipschutz added.