Anorexia: A Role for Law in Therapy?

Abstract

Anorexia nervosa poses particular challenges for medicine, for ethics and human rights, and for the law. These challenges are emblematic of wider dilemmas across mental health and adult guardianship law and its administration. They arise both in public law (legislation and tribunals), as well as in private planning (e.g. advance directives) and indeed also within civil society (extra-legal or ‘informal’ family and private arranging). It is suggested that those challenges are heightened by shrinkage in the role of the state, including services and public resources, under the guise of neoliberal governance and the ‘new public management’. Many of these public policy dilemmas are complex, finely balanced, and thus difficult to resolve with much conviction. This paper argues that there is some role for law in authorising coercive interventions on an ‘emergency’, life-saving basis in acute instances of severe anorexia nervosa, along with a wider role for adult guardianship orders as the preferred initial measure when intervention is required. While the law may be creatively reformed (or administered) to facilitate realising positive rights such as access to needed treatment and quality services, it is argued that the role of law in policing the legislatively-determined boundary between voluntary and involuntary detention and/or treatment remains its most critical contribution. It is suggested that only lip-service is paid to the discharge of this task at present, because insufficient time or resources are available to the review tribunals undertaking this work. Addressing such under-resourcing is posited as the most pressing and most immediate challenge in anorexia nervosa cases, as it is in mental heath and substitute decision-making systems generally.

Keywords: anorexia nervosa, coercion, ethics, mental health, adult guardianship

JEL Classification: K10, K30, K32