Eating disorders (EDs) are frightening and sometimes life-threatening, but they are usually treatable. Killing someone with an eating disorder, on the other hand, is untreatable. And as the legal boundaries of assisted suicide expand, more people with eating disorders are being killed than treated, a new study finds.
The study, published July 30 in the journal Frontiers in Psychiatry, claims to be “the first to systematically review all known cases of euthanasia for people with eating disorders from both peer-reviewed studies and official government reports.”
Diagnosis Murder
That proved to be a difficult task because “there are substantial gaps in reporting of euthanasia for people with mental illness, raising significant concerns about oversight and public safety,” wrote Chelsea Roff, executive director of the eating disorder recovery group Eat, Breathe Thrive, and Katherine Cook Cotton, a professor at the University at Buffalo who treats people with eating disorders.
“In many cases, the clinical evidence used to assert that eating disorder patients are candidates for euthanasia lacks validity and is inconsistent with empirical understanding,” the researchers continued.
At least 30 jurisdictions worldwide (including the United States) allow assisted suicide. Most require that the patient be terminally ill, but the authors argue that “laws rarely provide a comprehensive, clinically applicable explanation of how the terminal determination should be made.” Some jurisdictions have looser requirements, but typically require that the patient have an “irreversible condition causing intolerable suffering.” Physicians therefore have considerable discretion in determining whether a patient is eligible for assisted suicide.
But doctors are human, and their judgments are inevitably imperfect and reflect their own knowledge, biases, personal beliefs, and even fatigue from trying unsuccessfully to treat patients. Doctors tend to be pessimistic about their patients' chances of recovery, especially when patients suffer from mental rather than physical illnesses such as eating disorders.
Reports of anorexia
Roff and Cook-Cotton did their best to make sense of the available assisted suicide documentation, but were hampered by a “dearth” of assisted suicide-related research in the peer-reviewed literature and inconsistent, incomplete reports provided by governments that “contained little detailed information on the characteristics of patients who received assisted suicide (such as psychiatric diagnoses).” Nevertheless, they managed to identify “10 peer-reviewed articles and 20 government reports that described at least 60 assisted suicide patients who received assisted suicide between 2012 and 2024.”
Of these cases, the study found, “only 19 included a narrative case summary that included information about the patient and the clinical rationale used to justify euthanasia.” All of these patients were women, and the majority were under the age of 50.
The authors further found that:
All but one individual described in the case report had multiple comorbid psychiatric diagnoses. The rates of comorbidity were high, with 95% having one or more psychiatric disorders, 61% having three or more psychiatric disorders, and almost a quarter having four or more comorbid disorders.
Patients also had higher rates of depression, chronic suicidality, “poor social functioning” and self-harm.
Hungry for a cure – not for death
Given the limitations of physicians and the mental disorders of ED patients, determining that ED patients are incurable, are capable of choosing death, and have done so voluntarily raises significant ethical issues.
In their joint statement against assisted suicide due to eating disorders, Eat Breathe Thrive declares:
Eating disorders are treatable conditions that require timely and comprehensive treatment. The idea that eating disorders are incurable or terminal is not scientifically supported and is a dangerous misconception.
Even men who have suffered from ED for years can recover, but it may take a long time before signs of recovery appear.
In the United States, eating disorder patients who were euthanized were always diagnosed with terminal illness, as state assisted suicide laws require such a diagnosis. To get around this, the concept of “terminal anorexia” was created, which refers to a state in which patients give up further treatment and accept that death is inevitable. However, the study points out that “this concept of terminality deviates from the medical definition of a terminal condition by describing reversible cognitive behaviors as indicators of terminal illness. Unlike cancer or Alzheimer's disease, most of the medical complications associated with anorexia can be treated with adequate nutrition and weight restoration, even in severely debilitated patients.”
The numerous mental illnesses of ED patients, not to mention malnutrition, naturally affect their thought processes and call into question what is supposed to be a voluntary choice. The authors note that ED patients often “are unable to understand the consequences of their decision,” “lack insight into their disorder and its life-threatening risks,” and have an impaired “ability to identify and communicate their true wishes,” casting doubt on the authenticity of the spontaneity of the decision to end their life.
“Attributing autonomy to the manifestation of treatable mental disorders in order to grant a request for euthanasia reflects a fundamental misunderstanding of the nature of ED and its associated psychopathology, and an obfuscation of physicians' obligations to prevent harm,” Roff and Cook-Cotton argued.
Mercy or cruelty?
“We categorically deny the claim that assisted suicide is a form of compassionate care for people with eating disorders,” Eat Breathe Thrive said. “Compassionate care is consistent, effective treatment, not encouraging suicide.”
Unfortunately, from the moment physician-assisted euthanasia was legalized, euthanasia for people with eating disorders became inevitable. As Wesley Smith states:
Once the legalization train leaves the station, it can no longer be contained or controlled. In other words, once a society has decided on murder as an acceptable solution to human suffering, the category of “what can be killed” will continue to expand.
