Referring patients with severe eating disorders to critical care to facilitate assisted nutrition under restraint
The Intensive Care Society (ICS) welcomes and endorses Referring patients with severe eating disorders to critical care to facilitate assisted nutrition under restraint: a framework to support decision making in life-threatening situations. The framework was developed by the Faculty of Intensive Care Medicine (FICM) and the Royal College of Psychiatrists, with contributions from members of the ICS Legal and Ethical Advisory Group (LEAG), bringing critical care expertise to the ethical, legal and clinical considerations explored throughout the document.
The framework has been produced in response to a growing need from clinicians for guidance on some of the most complex and challenging situations encountered in practice. It focuses on adults with life-threatening complications of an eating disorder who are referred to critical care following a multidisciplinary decision that assisted nutrition is required to sustain life. While professional guidance exists on the management of eating disorders and the provision of assisted nutrition, there has been limited guidance addressing the particular challenges that arise when critical care services become involved.
These situations are rare, but they can require difficult decisions involving multiple specialties, including eating disorder services, liaison psychiatry, critical care, nursing teams, legal advisors and hospital leadership. The framework aims to support a shared understanding of roles and responsibilities across disciplines, improve communication between teams, and provide a structured approach to decision making when patients are critically unwell.
The document is not a clinical guideline and does not advocate for any particular course of treatment. Instead, it provides a framework to help clinicians navigate complex situations, balancing the patient's rights, wishes, physical health needs and overall welfare. Throughout, it emphasises that decisions should be made on an individual basis and that the least restrictive option should always be considered.
The development of the framework also benefited from the involvement of patients and lay representatives, helping to ensure that the perspectives of those with lived experience informed its content and recommendations. In addition to supporting healthcare professionals, the framework may also be useful in particularly complex cases where legal scrutiny or court involvement is required.
