What are the arguments for and against recognizing 'terminal' anorexia nervosa? A narrative review.

Abstract:

'Terminal anorexia nervosa' is a controversial diagnosis proposed to facilitate certain practices, such as medically assisted death. This narrative review summarizes reasons given in the literature for and against adopting the term 'terminal anorexia nervosa (T-AN)' for the purpose of examining the nature and extent of engagement between opposing sides in the debate. We sought articles referencing T-AN or a closely related concept that provided reasons for or against T-AN or closely related treatment decision-making. Fifty-seven articles were included, but thematic saturation was reached early. Three themes were found in arguments for adopting T-AN: forgoing 'excessive' or 'futile' treatment, respecting autonomy through heeding patient requests, and harm reduction through facilitating access to resources, including medically assisted death. Four themes were found in arguments against T-AN: difficulty of defining 'terminal' AN, difficulty with assessing capacity in AN, applying the label will cause harm to patients, and effort should instead be focused on improving systemic problems with the quality of and access to AN care. Although both sides raise important issues, there is a lack of shared understanding, especially concerning underlying value judgments embedded in perspectives on T-AN.