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Denial is a characteristic feature of anorexia nervosa (AN) that may lead to treatment refusal. If an individual is refusing treatment autonomously, it should be accepted, while a lack of autonomy indicates paternalistic intervention may be justified. AN has the highest mortality rate of any mental disorder, so accepting refusal means accepting the risk of death, so should only be done with the certainty that it is autonomous. The current research is theoretical, reviewing the literature on ethical issues relating to autonomy and paternalism in AN in order to evaluate the evidence base for these assumptions. The aim is to develop a procedural model for establishing autonomy in those with AN. The result is the anorexia nervosa autonomous decision-making model (ANDMM), which provides guidance for responding to autonomous and non-autonomous treatment refusal.

Consent or Caring? Issues of Autonomy and Paternalism in the Treatment of Anorexia Nervosa