A Harm-Reduction Approach for a Child with Avoidant/Restrictive Food Intake Disorder

Involuntary treatment of adolescent patients with treatment-resistant eating disorders poses a unique ethical problem. As pediatric patients mature, the burden on parents and the care team to justify and authorize involuntary medical treatment grows significantly. Essential considerations for the authorization of involuntary treatment for an adolescent include the ratio of risk to benefit for involuntary intervention and the decision-making capacity of the patient. The involuntary administration of hydration and nutrition to adolescent patients who have eating disorders poses unique challenges, particularly as these patients approach the age of majority and when there is insufficient evidence regarding the long-term effectiveness of involuntary artificial nutrition and hydration as a part of treatment for eating dis­ orders. In this article I suggest that a harm-reduction approach is an ethically defensible approach to balance commitments to respect the patient's autonomy with obligations to minimize harms and create an opportunity for benefit.