Anorexia and autonomy, continued.

[Update: I originally referred to a hypothetical anorexic throughout this post with the pronoun 'she'. This reflected that my initial post was sparked by a new legal ruling which did, indeed, involve an anorexic woman. But a friend has pointed out that by now it appears I am assuming anorexics are necessarily female, which is both false and thereby unhelpful. Neutral pronouns are now in place].

One final round on this oh-so tricky issue. Sullivan has aired a reader’s email criticising my anti-force-feeding stance:

If force feeding anorexics is wrong, then so is forcibly committing someone who is suicidal to an institution to protect them from themselves. To say it is wrong is to assume the person is capable of rational decision-making. In talking with a friend over the years about her eating disorder, I’ve come to think that such rationalism is just not the case.  Severe malnutrition affects decision-making as much as the skewed self-image that drives the behavior in the first place. Add the fact that the person may not have eaten in so long that doing so leads to severe nausea, creating a further aversion to eating, plus years of severe depression and hopelessness that can ultimately manifest as a death wish, and you’ve got an out-of-control situation that requires serious intervention.

Emphasis mine.

This is the same objection I considered yesterday: namely, that anorexia precludes autonomy by fostering irrationality, so force-feeding is fine. I started by wanting to know more about this invocation of “rationality”, but by the time it came to the comments thread I took up John Magruder’s suggestion that anorexics are irrational because they hold false beliefs about the effects of food, and my main concern was to doubt that, despite appearances, this type of irrationality can justify coercion.

Let me try to explain my reluctance on this issue, one final time.

Consider Jehovah’s Witnesses. Infamously, they oppose blood transfusions on the grounds that an individual’s blood is sacred and therefore sharing it is wrong. Now, they would no doubt claim that the truth of this principle depends upon the will of God, and we have no way of knowing whether it’s accurate. But for the sake of my point, this is irrelevant. It doesn’t matter that we cannot prove what we suspect: that, to put it mildly, their view is misguided. All we need to note is that even if we were sure that their view was nuts - even if we could somehow prove it – would we wish to care for them by compelling them to take blood donations accordingly? No. But why not? After all, those arguing for force-feeding anorexics were doing so by noting that they are irrational because they hold false beliefs; ex hypothesi, just like the Jehovah’s Witnesses.

Or maybe something less contentious will suffice. What about those that refuse conventional, certified-effective medicine and instead opt for homeopathy? Again, I take it as irrelevant that there could be some hidden benefits to this form of treatment. Even if we were sure it does nothing, so that the person would be acting on a false belief detrimental to their health, thereby being irrational and allegedly lacking autonomy – would we even consider coercing them?

What about the man who dies waiting under the illusion that God will intervene and save him?

I’m yet to understand why anorexia should be so different.

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3 thoughts on “Anorexia and autonomy, continued.

  1. Jehovah’s Witnesses believe that life is sacred to God therefore blood is sacred because it represents and symbolizes life. Jehovah’s Witnesses put a higher value on blood than they do life.
    Which is more sacred? The symbol or that which it symbolizes?
    Cults do get people killed!
    50-100 times as many men,women,children have been killed by the Watchtower society ban on *whole* blood transfusions than at Jonestown kool-aid mass murders.

    FMI ajwrb(dot)org Jehovah’s Witnesses blood reform site

  2. I think the main difference between an anorexic and a Jehovah’s Witness, Hunger Striker, etc is that they are mentally unstable because the brain with which they need to reason is lacking energy. A criterion of rationality is admittedly tricky but perhaps a minimum requirement is not so difficult, such as the person in question needs to have enough energy in order for their brain to function well. This minimum need not be too heavy but anyone who cannot get out of bed due to lack of energy is surely unable to reason as the body prioritises key functions and reason is not one of these. Admittedly the person in question will be able to tell if you are doing something to them, such as force feeding them, but that is mainly because their body is going “look out we’re being attacked”

    Another way to look at it would be to argue that anorexics do not wish to die, in much the same way I do not wish to die. So if I were drowning and flailing around it would appear that I did not want assistance because it appears I am hitting out at anyone who comes near.

  3. Good points, Jacob. Thanks for the discussion, and I certainly can’t offer an assured conclusion.

    What about the man who dies waiting under the illusion that God will intervene and save him?

    The difference, for me, is that bogus as this man’s ideas are they’re his. His arrival at them is a consequence of his own thought processes. When I was severely, on the other hand, anorexic I wasn’t expressing “beliefs” and “convictions” I’d arrived at but manifesting symptoms that were almost entirely the product of malnutrition rather than my own intelligence, experiences and thought. (Ancel Keys’ study, linked to earlier, backs up the claim that the physiological consequences of starvation appear to cause psychological features associated with severe AN.)

    If somebody decided to climb up the side of a mountain without ropes I might be inclined to let them if they were operating at the peak of their mental faculties. If they’d dropped a tab of LSD, however, or even if they really fatigued or feverish, I’d be inclined to think that one would be justified in restraining them at least until they were sober. (In whatever sense.) I might think one’s claim to autonomy, then, can be undermined by the extent to which one’s psychological processes are influenced by one’s physiological state. It’s not so much the ends one seeks, according to this view, that are significant but the means by which they’ve come to be sought.

    But, as I say, these are somewhat prejudicial thoughts. Even people stricken with the worst forms of AN must be themselves to some extent – one doesn’t acquire a wholly new personality – and I’m not fit to be the one to tell them how great it is.

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