Involuntary hospitalization of patients who suffer from severe Anorexia Nervosa is not detrimental to their recovery process and achieves similar positive results to those of patients who were voluntarily hospitalized. This is according to a new study conducted by researchers at the University of Haifa. “This finding is very significant and should be a milestone for further legislation of the bill allowing forced treatment of severe anorexia patients, which passed its initial reading in February 2012. The bill will make the difference between life and death for these patients,” said Prof. Yael Latzer of the Faculty of Social Welfare and Health Sciences of the University of Haifa.
Anorexia Nervosa affects between 0.5%-1% of women during their lifetimes, and about one tenth of that number of men. Even when the condition of patients is life-threatening, they are not defined under the Treatment of Mental Patients Law of 1991 as mentally ill, and cannot be hospitalized involuntarily. In extreme cases, the court may appoint a guardian, usually a parent, who can agree to the involuntary hospitalization of the patient. This marks the beginning of a process that results in very few patients actually being forcibly hospitalized, and even then they can leave treatment after there have been certain improvements in their condition.
Inasmuch as treatment in extreme cases of the illness requires the cooperation of patients, one of the arguments of those who oppose involuntary hospitalization of patients with Anorexia Nervosa is that, beyond the legal question of a person’s freedom of choice, involuntary hospitalization is an ineffective tool that will not improve the health conditions of patients. Back in February of 2012, the Knesset passed an initial reading of a bill allowing for the compulsory treatment of patients with extreme anorexia, but the dissolution of the Knesset halted the legislative process, and it has not been renewed since.
In regard to the constitutional question regarding one’s freedom of choice, Prof. Latzer said that anorexia is a serious mental problem which places patients into a state of extreme malnutrition. “This condition impairs the cognitive ability of patients to make sound judgments and to correctly perceive the life-threatening condition that they are in. “Therefore”, Latzer concludes, “it is very important to help them save their own lives. Because of this situation, the legislation of this bill should be included in future parliamentary laws. The law would stand to benefit the individual, even though his/her freedom of choice is taken away to some degree for a period of their life”.
In the present study, which was performed by Prof. Latzer who is the director of the Eating Disorders Clinic at Rambam Medical Center, research student Adit Zohr-Beja, and Dr. Eitan Gur from the Eating Disorders Department of Sheba Medical Center, the researchers sought to examine claims concerning the ineffectiveness of involuntary hospitalization, and determine whether there is a difference in outcomes between patients who were forcibly hospitalized versus those who were willingly hospitalized. To do this, 79 patients were examined over the last decade. Twenty-eight of them were involuntarily hospitalized by the courts and fifty-one were hospitalized of their own free will. The clinical data (body mass index, or BMI, blood pressure, pulse and more) upon admission of both groups were similar.
The study showed that compulsory treatment and voluntary treatment both led to the same positive outcomes. According to the researchers, despite the declared reluctance to receive treatment of those involuntarily hospitalized, their response to treatment was good. Moreover, it was found that compulsory treatment could reduce feelings of guilt in patients relating to receiving suitable treatment and nutrition. It was also found that the duration of hospitalization for both groups was similar, as was the rate of mortality. Likewise, patients from both groups gained weight at a similar rate and a similar percentage joined rehabilitation programs after being released from the hospital.
“This study confirms previous research findings that the refusal of patients to receive treatment, and their perception of the eating disorder, may change during treatment, even in cases of the patient receiving treatment against their initial will. Although forced hospitalization is complicated for the patient, their family and the hospital staff, it is sometimes necessary in order to save the patient’s life. It is our duty as a society to provide compulsory treatment to patients until they are once again able to make sound judgments,” Professor Latzer concluded.