Resisting Contagious Hopelessness: Therapeutic Alliance and the Limits of Physician-Assisted Death in Severe and Enduring Anorexia Nervosa.

Abstract

Contemporary psychiatric ethics emphasize autonomy and shared decision-making, yet these frameworks may be strained in severe mental illnesses characterized by cognitive rigidity, fluctuating decisional capacity, and undue clinician influence. Severe and enduring anorexia nervosa serves as a case example to explore how therapeutic alliance, clinician expectations, and suggestibility may shape expressions of choice in high-stakes decision-making, including discussions of physician-assisted death. Drawing on psychotherapy theory, placebo science, and clinical outcome data, this paper argues that clinician framing and prognostic stance function as treatment variables that may transmit either hope or hopelessness. Ongoing therapeutic engagement focused on improving quality of life and the instillation and preservation of hope should precede any consideration of end-of-life interventions.