Three Sources of Incapacity in Anorexia Nervosa

Patients who are diagnosed with anorexia nervosa (AN patients) characteristically refuse to receive medical treatment, including life-saving treatment, for their illness. These refusals are generally not honored on the grounds that AN patients are incapable of making autonomous medical decisions regarding their illness. Despite being widely shared by medical and legal experts, the judgment that AN patients are incapable of medical decision-making lacks a sound theoretical basis in the existing bioethics literature. This paper aims to fill this gap in the literature by offering a novel explanation of AN patients' incapacity. AN patients, I propose, are subject to three sources of incapacity: deep internal conflict, compulsion, and irrationality. I discuss the theoretical and practical implications of my proposal, including the challenge that it poses to the capacity model that is standardly used by clinicians in the United States.