When diagnosis limits possibility: ethical concerns regarding terminality constructs in eating disorders.

Abstract

Recent debates regarding assisted death in eating disorders have intensified alongside increasing use of constructs such as severe and enduring anorexia nervosa (SE-AN), severe and enduring eating disorder (SEED), and terminal anorexia nervosa (T-AN), none of which are formally recognized diagnostic entities. While these terms are intended by some clinicians to acknowledge profound suffering and longstanding illness, we argue they may also shape illness identity, influence expectations regarding prognosis, and contribute to perceptions of treatment futility within under-resourced systems. Rather than reflecting discrete clinical entities, these constructs may inadvertently transform systemic limitations into assumptions about individual recovery potential. We further examine how such assumptions intersect with ethical debates surrounding assisted death, particularly in the context of inconsistent mental-capacity assessment, treatment inequities, and limited access to adapted care. Drawing on clinical expertise, research scholarship, and lived experience, we propose a middle ground that acknowledges chronic suffering while rejecting assumptions of terminality, emphasizing integrated, trauma-informed, neurodiversity-affirming, and recovery-oriented treatment.