Search

© 2014 The Author. This paper reports on an ethnographic study conducted in two eating disorders treatment settings in New South Wales, Australia. The study set out to make a social work contribution to the debate on the ethics of involuntary treatment for anorexia nervosa (AN) drawing on the authors' practice experience. An empirical ethics approach was taken to support a reflective process of theorising from practice focused on how the treatment decision-making context is relevant for ethics. Three key issues of relevance for social work and the ethics debate were revealed: (i) the operation of power, knowledge and values affirms particular knowledge during treatment decision making that may justify the use of paternalism; (ii) particular knowledge and values are privileged in the treatment environment and associated with 'good practice' and 'professionalism'. This may or may not promote the core social work values of 'empowerment', 'participation' and 'self-determination'; (iii) the operation of power, knowledge and values has implications for the patient-professional relationship that may be counterproductive to recovery from AN.

A review of the issues surrounding a Ulysses contract--a prior consent agreement--juxtaposes the autonomy expressed by a stabilized patient who gives consent in advance for treatment during an acute break and the exercise of a patient's right to refuse as protected by legal advocates. Ideally, the first approach would enable persons to claim control over their lives and promote a collaborative process involving patient, family members, and professionals. But feedback from an informal canvassing of individuals representing various vantage points emphasizes concern about safeguards and monitoring the use of these contracts. Although several legal avenues may be open, both theoretical and technical obstacles can block the road to voluntary involuntary treatment. We hope this article will serve as a stimulus for an open exchange about ways to ensure one's right to protect oneself from the consequences of psychosis.

Over the four years from 1 January 1985 to 31 December 1988, 192 patients were treated for aortoiliac occlusive disease by the Oxford Regional Vascular Service. The number of patients treated by percutaneous transluminal angioplasty increased from two in the first year of the study to 34 in the third year of the study. This increase was accompanied by a decrease in the proportion of patients treated by aortobifemoral bypass but the proportion of patients treated by extra-anatomic bypass remained constant at around 30 per cent. Twice as many patients were treated in the fourth year as in the first year of the study so that the number of surgical operations increased despite many patients being treated exclusively by percutaneous transluminal angioplasty. The number of patients requiring mandatory treatment for limb salvage increased by 109 per cent and optional treatment for intermittent claudication by 85 per cent. The introduction of percutaneous transluminal angioplasty in Oxford has coincided with an increase in the number of patients presenting with symptomatic aortoiliac occlusive disease and has allowed twice as many people to be treated while the number of aortobifemoral bypass operations has remained unchanged. It is concluded that the introduction of percutaneous transluminal angioplasty has not only generated its own workload but has also led to an increased demand for surgical reconstruction for aortoiliac occlusive disease.