Should patients be allowed to die of anorexia?

A few days later, when she was no longer likely to die, Naomi announced she was going home — and the hospital responded by putting her on mental health care for 72 hours. Doctors then obtained what Colorado calls a short-term certification, which, by court order, required Naomi to be restrained and treated, in her case until she reached what doctors said was 80 percent of her “ideal body weight.” In Colorado, as in most states, a patient can be treated against her will if she is mentally ill and unable to make informed decisions. That day, Naomi was transferred to a residential program at the Eating Recovery Center (ERC) in Denver.

“I’m so angry, I’m so angry,” Naomi said in another video message, her voice dull and impassive. “I was completely disrespected. I was cheated.” Naomi felt her mind deteriorating – it was too slow, too weak – but she found she could think in a straight line. She could reason. Why then did the doctors say otherwise? By then, she had been in and out of hospitals, psychiatric wards and eating disorder programs, including the ERC, more times than she cared to remember. Was it really so irrational of her to assume that trying the same treatment for the hundredth time would be futile?

When she was a teenager, Naomi believed that treatment programs could save her. She ate meals under supervision and attended group therapy sessions where patients discussed, among other things, the origins and possible psychological functions of their eating disorder. Sometimes Naomi told the story that she stopped eating because she thought it would make her a faster swimmer. Or the one about how she just wanted to be special, like her oldest brother was special because he was so smart. Other times she told the story about the day her grandfather died and the whole family went to eat at a restaurant. Naomi was revolted to see everyone nourishing their bodies with something as carnal as food, when they should have been overwhelmed with grief. Years later, it was hard to say whether these origin stories mattered. Naomi gained weight with each hospital admission. Each time, the extra weight felt unbearable, and she lost it soon after discharge.

As the years passed, Naomi found it increasingly difficult to be “compliant” with standard treatment. She refused to participate in group sessions. Or she withdrew during therapy, which she found infantile and pointless. She sometimes tampered with her intravenous lines because it was too horrible to watch those plastic bags of liquid calories empty into her body. During some tapings, Naomi forced herself to gain weight so she could be fired. Other times she opted out against medical advice. Later Naomi started eating and purging. She excused herself after dinner and went into the backyard to throw up in plastic bags that she threw into the neighbor’s yard so no one would see. She vomited and vomited until stomach acid burned through the enamel of her teeth and she had to spend $22,000 to replace them.

Between treatment programs and emergency admissions, Naomi went to college at the age of 18. She wanted to study psychology, but really all she could do was exercise for hours a day after eating next to nothing, maybe an apple. She dropped out in her senior year. Later, she found jobs she enjoyed — a certified nursing assistant doing home health assessments, a patient coordinator at a hospital — but they were often interrupted by yet another medical admission.