Ethics is a cornerstone of eating disorder care. It provides a framework for clinical decision-making and practice, differentiating “good” from “bad” and “right” from “wrong.” Though there are no hard and fast rules for clinicians approaching situations of ethical concern, every decision is guided by a moral code. In this blog, we will explore key ethical principles and dilemmas facing eating disorder treatment providers.
Key Ethical Principles
Eating disorders are complex mental and physical illnesses. Ethics in the treatment of eating disorders share this same complexity. From the moment a potential client makes the first call to our admissions team to the time that a client finishes treatment, ethical considerations are constantly at work. Each member of the multidisciplinary treatment team must adhere to the professional standards set by the organizations that license, certify, and support them, while the team collectively upholds the highest standard of client care.
Ethical principles in the treatment of eating disorders include, but are not limited to:
- Informed consent
- Duty to protect
In the treatment of clients with eating disorders, we often find ourselves faced with conflicting ethical principles, and the path to “right” or “wrong” is not clear.
Examples of these ethical dilemmas include:
- Power of the therapeutic relationship: The therapeutic relationship is one of the strongest indicators of client outcomes. A strong and authentic therapeutic relationship has the power to motivate a client to change or agree to a recommendation for an alternative treatment setting or higher level of care.
- Understanding resistance: Resistance is reinforced by the adaptive and functional characteristics of the eating disorder. Providers work as a team to explore a client’s motivation for change and willingness for recovery. Resistance is often driven by physical factors, including BMI, the severity of comorbidities, and purging behaviors.
- Treating clients against their will: Involuntary treatment introduces many ethical considerations. There is a hierarchy of various ways to communicate a treatment recommendation. Depending on the recommendations, some treatments may be considered a violation of a client’s autonomy and necessary for survival. In the daily work that we do, we often do not get to make these difficult decisions.
- Treating clients at a lower level of care than is clinically indicated: Sometimes clients and families who receive a recommendation for a higher level of care prefer to remain at the current level of care even when not medically or clinically indicated. We must recognize that client’s desires while also making sure they have all the information to make the best decision possible.
- Attending to our biases as providers: We all have biases. Ongoing supervision and consultation are necessary for all providers regardless of how long one may have been doing this most important work. There is no shame in seeking out consultation and supervision!
- Honoring the provider’s personal experience: Many clinicians are drawn to our collaborative industry as a way to give back and help those who are in a place they once were themselves. Providers in recovery or who are recovered need to be aware of their own degree of recovery. Monitoring boundaries and engaging in ongoing supervision are key to maintaining our own wellness and self-awareness.
Ethics in the treatment of eating disorders requires providers to not only consider ethical principles but personal factors as well. Considering these things allows us to provide quality care for our clients grounded in integrity, competence, and compassion.