Treatment decisions at the end of life: What if they're still standing?

Clinical and managerial decision-making have been traditionally mutually exclusive entities. Recent advances in medical technology and therapeutics however, including chemical nutrition and psychopharmacology, have prompted a questioning of this heretofore professional courtesy. This laissez faire approach to clinical professional turf is particularly problematic when patients' civil liberties are constrained in situations in which the patient has little, if any, real control, e.g. psychiatric inpatient admissions. This paper seeks to examine an area of managerial and clinical conflict-the realm of the care and involuntary treatment of patients with anorexia nervosa. Specifically addressed are the concerns raised by a conflict between competent psychiatric inpatients' refusals of treatment, medical management based on research protocols, and managerial distancing from the issue.