Jamieson Sacha Kendall, Tan Jacinta, Piekunka Kym, Calvert Shannon, Anderson Stephen
Sydney School of Education and Social Work, The University of Sydney, Sydney, Australia.
Imperial College London and My Lighthouse Ltd, London, UK.
J Eat Disord. 2024 Sep 6;12(1):134. doi: 10.1186/s40337-024-01082-0.
Decisions about the treatment of eating disorders do not occur in a socio-political vacuum. They are shaped by power relations that produce categories of risk and determine who is worthy of care. This impacts who gets access to care and recognition of rights in mental health services. Globally, there are calls for more human rights-based approaches in mental health services to reduce coercion, improve collaborative decision making and enhance community care. Treating individuals with longstanding, Severe and Enduring Eating Disorders (SEED) or Severe and Enduring Anorexia Nervosa (SE-AN) can be particularly problematic when it involves highly controversial issues such as treatment withdrawal and end-of-life decisions and, where legally permissible, medically assisted dying. In this article, we argue that the socio-political context in which clinical decision making occurs must be accounted for in these ethical considerations. This encompasses considerations of how power and resources are distributed, who controls these decisions, who benefits and who is harmed by these decisions, who is excluded from services, and who is marginalised in decision making processes. The article also presents tools for critically reflective practice and collaborative decision-making that can support clinicians in considering power factors in their practice and assisting individuals with longstanding eating disorders, SEED and SE-AN to attain their rights in mental health services.
饮食失调治疗决策并非在社会政治真空中做出。它们受到权力关系的影响，这些权力关系产生了风险类别并决定了谁值得接受治疗。这影响了谁能够获得心理健康服务以及谁的权利能够得到认可。在全球范围内，人们呼吁在心理健康服务中采用更多基于人权的方法，以减少强制手段、改善共同决策并加强社区护理。治疗患有长期、严重且持续的饮食失调症（SEED）或严重且持续的神经性厌食症（SE-AN）的个体可能会特别棘手，因为这涉及到诸如停止治疗和临终决策等极具争议的问题，以及在法律允许的情况下的医疗协助死亡。在本文中，我们认为在这些伦理考量中必须考虑临床决策所处的社会政治背景。这包括对权力和资源如何分配、谁控制这些决策、谁从这些决策中受益以及谁受到伤害、谁被排除在服务之外以及谁在决策过程中被边缘化等问题的考量。本文还介绍了批判性反思实践和共同决策的工具，这些工具可以帮助临床医生在实践中考虑权力因素，并协助患有长期饮食失调症、SEED和SE-AN的个体在心理健康服务中获得他们的权利。
