Human Rights and Human Experience in Eating Disorders

Over the last quarter century, hospital admissions for eating disorders such as anorexia nervosa have continued to rise. During that same period, the law pertaining to food-refusal has
generated new challenges. New legal principles have come to prominence in the ongoing effort to introduce robust human rights protections in care settings. And we are seeing a subtle but important shift in the legal framework within which cases of persistent food-refusal are adjudicated. An earlier legal approach could focus narrowly on questions of whether, for example, anorexia nervosa is a mental disorder, whether a particular person living with anorexia presents a ‘danger to self or others,’ and whether involuntary hospital treatment is effective. By contrast, the emerging legal approach explicitly requires attention to the decision making processes at work in food-refusal, and to the ‘beliefs and values’ that inform a person’s ‘will and preferences’ – both as regards food and as regards treatment. The old questions were hard. The new questions are harder, and they call for new forms of investigation into the phenomenology and psychosocial dynamics of food-refusal.

In this paper, I consider four examples of legal principles that have application in this arena. One example comes from international human rights law; the others derive from a domestic
English statute and associated case law. But the issues they raise transcend any one legal jurisdiction. I shall not here propose answers to the questions raised by the application of these principles to food-refusal. Indeed, my principal conclusion shall be that we are not yet equipped to answer them. But if we can bring the questions themselves more clearly into view then we may also be able to develop collaborative, multi-disciplinary research methods suitable for addressing them.

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