I appreciate your perspective on this and thank you for sharing the story of lovely Dee. I think the problem with Gaudianiâs article is the emphasis she placed on medical assistance in dying (MAID). She acknowledged that for some people with extremely severe, long-term and seemingly treatment-resistant anorexia, there are cases where a palliative approach, focussing on harm reduction and comfort, rather than a recovery-focussed approach, would be more appropriate. Like in end of life hospice care, in the very severe stages of this the focus would be on spending time with family and reducing pain. In this approach the more peaceful time and focus on keeping existing relationships might be comfort before death and in some cases can foster some hope for recovery. But I think the idea of âterminal anorexiaâ requiring MAID is so dangerous - I imagine it is almost ubiquitous that at some point in an ED you believe that you will never recover and would be better off dead. Gaudiani endorsing the idea that there are some people who can never get better - in some equivalence to those with something like an incurable cancer - is a really dangerous idea to put out onto the internet for vulnerable people who are at this very lowest stage might find. I have certainly been at this point and having persistent reminders that even though it is extremely difficult, I could (and did!) recover was so valuable. It seems that in the NHS, there is not a provision for palliative care for these severe cases. But a gentle end of life (assisted by pain relief as in other hospice care) could have been an option for the patients described in the original article, which is very different from administering MAID when death would have been far off for them. Sadly I think Gaudianiâs article will already have done some damage by making people who would go on to recover believe that there is no hope for them. I really recommend Mack & Stantonâs response (Responding to âTerminal anorexia nervosa: three cases and proposed clinical characteristicsâ) in Journal of Eating Disorders which I think provides an empathetic and reasoned argument against Gaudiani here.
I appreciate your perspective on this and thank you for sharing the story of lovely Dee. I think the problem with Gaudianiâs article is the emphasis she placed on medical assistance in dying (MAID). She acknowledged that for some people with extremely severe, long-term and seemingly treatment-resistant anorexia, there are cases where a palliative approach, focussing on harm reduction and comfort, rather than a recovery-focussed approach, would be more appropriate. Like in end of life hospice care, in the very severe stages of this the focus would be on spending time with family and reducing pain. In this approach the more peaceful time and focus on keeping existing relationships might be comfort before death and in some cases can foster some hope for recovery. But I think the idea of âterminal anorexiaâ requiring MAID is so dangerous - I imagine it is almost ubiquitous that at some point in an ED you believe that you will never recover and would be better off dead. Gaudiani endorsing the idea that there are some people who can never get better - in some equivalence to those with something like an incurable cancer - is a really dangerous idea to put out onto the internet for vulnerable people who are at this very lowest stage might find. I have certainly been at this point and having persistent reminders that even though it is extremely difficult, I could (and did!) recover was so valuable. It seems that in the NHS, there is not a provision for palliative care for these severe cases. But a gentle end of life (assisted by pain relief as in other hospice care) could have been an option for the patients described in the original article, which is very different from administering MAID when death would have been far off for them. Sadly I think Gaudianiâs article will already have done some damage by making people who would go on to recover believe that there is no hope for them. I really recommend Mack & Stantonâs response (Responding to âTerminal anorexia nervosa: three cases and proposed clinical characteristicsâ) in Journal of Eating Disorders which I think provides an empathetic and reasoned argument against Gaudiani here.