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Agency, ambivalence and authenticity: the many ways in which anorexia nervosa can affect autonomy1

Published online by Cambridge University Press:  19 February 2013

Tony Hope ,
Jacinta Tan ,
Anne Stewart  and
John McMillan
Tony Hope*
Affiliation:
The Ethox Centre, Department of Public Health, University of Oxford
Jacinta Tan
Affiliation:
Department of Interprofessional Health Studies (Philosophy, History and Law), College of Health and Human Sciences, Swansea University
Anne Stewart
Affiliation:
Oxford Health NHS Foundation Trust and University of Oxford
John McMillan
Affiliation:
Bioethics Centre, University of Otago
*
tony.hope@ethox.ox.ac.uk
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Abstract

On the basis of detailed interviews of females aged between fifteen and twenty-six years with a diagnosis of anorexia nervosa we argue that the autonomy of people with this condition may be severely compromised in four ways, particularly in relation to eating and weight. First there are problems with agency. Second, affective components, particularly anxiety, can dominate beliefs such that the grounds for making a decision may differ from the reasons given in justification. Third, the interactions between the affective components and the objective evidence lead to substantial inner conflicts with resulting lack of stability in preferences and beliefs. Fourth, this lack of stability leads to concerns around identity and authenticity. We argue that some of the ways in which autonomy is compromised reduce competence to decide on treatment. We suggest that these results may be relevant to other mental disorders and have clinical and policy implications.

Type
Articles
Information
International Journal of Law in Context , Volume 9 , Special Issue 1: Mental capacity and value neutrality , March 2013 , pp. 20 - 36
Copyright
Copyright © Cambridge University Press 2013

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Footnotes

1

We would like to thank all the participants in the study described in this article for their time and willingness to share their experiences; and Chris Fairburn for advice concerning the study. Ray Fitzpatrick provided invaluable support and supervision throughout the designing and carrying out of the empirical study. To him we are particularly grateful. TH would like to thank The Fondation Brocher [www.brocher.ch], the Hastings Center [www.thehastingscenter.org] and the Uehiro Foundation and Centre, for support during his times as a visiting researcher at these institutions. Finally we would like to thank the Wellcome Trust for funding much of this research including the collection of data.

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