Involuntary hospitalization of patients with anorexia nervosa in severe condition is not detrimental to their recovery process and achieves similar positive results to those of patients who were willingly hospitalized. This is according to a new study conducted by the University of Haifa. “This finding is very significant and should be a milestone for further legislation of the bill allowing forced treatment of anorexia patients whose lives are at risk, 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 0.5%-1% of women during their lifetimes, and about one tenth that number of men, putting the lives of patients with anorexia at risk in severe cases of the illness. 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, even if they refuse to willingly enter an inpatient program in order to receive treatment. In extreme cases the court may appoint a guardian, usually a parent, who can agree to the involuntary hospitalization of the patient — a process that results in very few patients actually being forcibly hospitalized, and even then they can leave treatment after there has been certain improvement in their condition.
Treatment in extreme cases of the illness requires the cooperation of patients, and as such one of the arguments of those who oppose compulsory 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 anorexia in life-threatening condition, but the dissolution of the Knesset halted the legislative process, and it has not been renewed since.
In regard to the constitutional question, Prof. Latzer says that anorexia is a serious mental problem and patients with anorexia are in a state of extreme malnutrition. This condition is known to impair the cognitive ability of patients to make sound judgments and to correctly perceive the life-threatening condition that they are in. Therefore it is very important to help them save their own lives. In this kind of situation the legislation of this kind of bill should be included in future parliamentary laws that are intended to benefit the individual, even though their freedom of choice is taken away to some degree for a period of their life.
In the present study, performed by Prof. Latzer who is also the director of the Eating Disorders Clinic at Rambam Medical Center, the research student Adit Zohr-Beja, and Dr. Eitan Gur from the Eating Disorders Department, Sheba Medical Center, Tel Hashomer, the researchers sought to examine claims concerning the ineffectiveness of involuntary hospitalization and examined whether there is a difference in outcome between patients in extreme condition who were forcibly hospitalized and those who were hospitalized willingly. 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 for treatment of their own free will. The clinical data (body mass index, or BMI, blood pressure, pulse and more) on admission of those hospitalized involuntarily were similar to those hospitalized voluntarily.
The study showed that compulsory treatment and voluntary treatment both led to the same positive outcome. 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 guilty feelings in patients in relation to receiving suitable treatment and the nutrition they require. 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 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 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.