Compulsory Treatment in Anorexia Nervosa: The Case of Israel

Anorexia Nervosa (AN) is a serious mental illness associated with high morbidity and mortality rates. Nevertheless, patients with AN are prone to refusing treatment despite life-threatening complications, requiring at times compulsory intervention. Involuntary treatment of eating disorders (EDs) through legal commitment is a controversial issue. In such cases, patient autonomy may conflict with protection of his or her best interest. In many industrialized countries, it is impossible to legally mandate treatment of patients with severe and even life threatening AN. In the last decade the ethical and legal concerns about compulsory treatment in Israel have been on the rise. According to the current law in Israel, it is illegal, with a few exceptions, to enforce treatment against the patient’s will.The aim of this paper is to review the existing literature about the legal and ethical dilemmas associated with compulsory treatment in AN and the effectiveness of its treatment outcomes. Research findings included in this review address both perspectives of the debate and discuss the patient’s competence to make this decision. Additionally, this paper focuses on the legal process in Israel in the last decade, illustrating the dilemmas in two case studies. This review raises important questions and clinical implications that must be addressed in further research

Compulsory Treatment for Anorexia Nervosa in Israel: Clinical Outcomes and Compliance.

Objective: Anorexia nervosa (AN) is associated with high morbidity and mortality rates, sometimes requiring compulsory treatment when patients refuse treatment despite life-threatening complications. Compulsory treatment of AN patients involving legal commitment is controversial in Israel, both ethically and legislatively. This study aimed to conduct a comprehensive retrospective examination of patient records to compare compulsory versus voluntary admissions regarding illness severity, admission, hospitalization, and outcomes.Method: Participants were 51 voluntary and 28 committed patients with severe AN admitted to a major Israeli ED department in 2003-2013. Demographic, clinical, physical, historical, and outcome data were collected through patients’ charts.Results: No significant group differences emerged between the groups in most variables. Two main differences were found: Committed patients had higher rates of comorbid personality disorders (33% vs. 10%) and significantly more disturbed nutrition patterns (44% vs. 26%) than voluntary patients. The two groups showed similar treatment outcomes in terms of weight gain (M = 9.7 kg), mortality rate (7.6%), and rehabilitation after hospitalization (15.2%).Conclusions: Results indicate that compulsory treatment may be as beneficial as voluntary treatment, both in the short and long term. After their initial resistance, compulsory patients were found to comply with the treatment and remain in the ED center to the same extent as those admitted voluntarily. Thus, compulsory hospitalization may reduce such patients' guilt about accepting nutrition and treatment. Compulsory treatment for severe life-threatening AN may save lives and should be implemented more commonly and earlier