The eating disorder community experienced perhaps more than its usual share of oddities, dysfunctionalities, egos out of control and lack of progress in the first half of 2022. And yet, one person managed to elevate herself to the very bottom of the bottom of the barrel.

A New Dr. Death

Jack “Dr.  Death” Kevorkian was a pathologist and euthanasia proponent. In 1997, Dr. Kevorkian was put on trial for his direct role in a case of voluntary euthanasia involving Thomas Youk. Youk suffered from Lou Gehrig’s disease, a/k/a ALS. Kevorkian was convicted of second-degree murder and served 8 years of a 10-to-25-year prison sentence.

In mid-March 2022, for reasons known only to God and broccoli, the Journal of Eating Disorders published an article entitled, “Terminal Anorexia Nervosa: Three Cases and Proposed Clinical Characteristics.”  Its lead author was the new “Dr. Death,” Jennifer L. Gaudiani.

Gaudiani’s article:

(1).     Postulated that severe and enduring anorexia nervosa is a terminal illness;

(2).     Attempted to establish clinical characteristics for those patients whom Gaudiani considers to have Terminal Severe and Enduring Anorexia Nervosa (“TSEAN”);

(3).     Attempted to establish objective, clinical guidelines for TSEAN.

The private response was immediate.

Gaudiani should be commended for accomplishing a herculean task that most considered virtually impossible. And that is … she was able to bring together, to unify as one, all persons, doctors, research professionals, organizations and all other aspects of the eating disorder community and industry in one great, collaborative. To a person, every entity looked upon Gaudiani’s viewpoints with horror and derision. Clinical doctors, research professionals and advocates used the following words to describe Gaudiani’s article, “reprehensible, appalling, irresponsible and horrifying.” Naturally, public admonition came only from those outside of the eating disorder realm since “sacred cows” in the eating disorder community are deemed untouchable. Apparently, no matter what.

Not only was Gaudiani the author of this article, but she was the internist for the three guinea pigs … err, patients who were the subjects of the article. Three souls for whom Gaudiani was complicit in, if not the catalyst for, removing the very last vestige of one of the most important aspects of recovery. That is … hope.

To say there is a legion of troubling issues with Gaudiani’s article and thinking, or lack thereof, would be charitable. Nonetheless, let’s address just a few of the more obvious issues.

First, the article did not mention, let alone explain that severe anorexia can decrease brain volume. Studies indicate that individuals with prolonged anorexia have the most significant reductions in brain volume among all study participants.

Shrinkage of the brain and brain atrophy can affect cognitive functioning. The National Institute of Neurological Disorders and Stroke states that brain atrophy can result in several health conditions, including:

  • Dementia: Creates problems with memory, abstract thinking, learning, organizing, and planning
  • Aphasias: Involves problems speaking and understanding language
  • Seizures: Characterized by convulsions and sometimes a loss of consciousness

Second, did Gaudiani take into account oxytocin levels in the brain? Research evidence shows that varying levels of oxytocin, a brain chemical, have an impact on anorexia. Now, three new studies of the hormone—best known for its role in bonding lovers to each other and parents to their children—suggest that addressing oxytocin levels may be a viable treatment for anorexia, which as we know, currently has no effective pharmacological medication and relies for the most part on therapy.

Third, Gaudiani’s “treatment” of her patients violate the AMA Code of Ethics Opinion 5.7 which states in material part: Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Physicians:

  1. Should not abandon a patient once it is determined that cure is impossible.
  2. Must respect patient autonomy.
  3. Must provide good communication and emotional support.
  4. Must provide appropriate comfort care and adequate pain control.

Fourth, professional groups, such as the World Medical Association, the British Medical Association, the American Medical Association,and the American Psychiatric Associationhave all expressed unwavering opposition to MAiD.

Forty (40) states in the United States ban assisted suicide.

In an article published in July of 2021 by the Canadian Medical Association Journal entitled, “Deromanticizing medical assistance in dying,” the authors stated in material part as follows:

“Dr. Ashe speaks of providing MAiD as an “intimate and sacred moment.” We trust that he meant the interaction with the suffering patient and family before administration of the medications to end a life. Rocuronium, which paralyzes the neuromuscular junction and terminates life, does not allow for any expression of what the patient is feeling. We do not believe it is in the best interest of others to portray MAiD as something people should seek instead of natural death…”

“… writing about MAiD in a romanticized way may influence vulnerable people to seek MAiD through social learning, whereby they identify with the person portrayed and seek to copy their behaviour. This has been previously reported in 2003 in Switzerland.”

“We would not have the medical advances and healthier, longer lives we have today if previous clinicians all considered an easier death to be the solution to the burden of disease. We need to continue to research and seek ways of preventing and relieving suffering.”

Then there is the ethical aspect, or lack thereof, of Gaudiani’s article. Some ethics experts define Gaudiani’s conduct as abandonment. Bioethics writer Wesley J. Smith, writing in the National Review about abandonment stated, “Then why not allow an intentional, lethal opioid overdose as a “treatment” for opioid use disorder? Once you open the door for one by redefining it as “terminal,” you won’t be able to keep others out. When psychiatrists give up on their mentally ill patients — and indeed, are allowed to help them commit suicide — who will defend the value andcontinued importance of their lives? How will these very unhappy people be kept among us during their darkest days?”

When interviewed, Gaudiani insisted that physician assisted suicide is not suicide: “MAid (Medical Assistance in dying) is offered to individuals whose death is inevitable within six months from an underlying disease process; it provides patients a choice in how they die, not whether they die. It is not a means of suicide.” “When death is inevitable?” “… not a means of suicide?” Good Lord.

Gaudiani’s statement is nothing more than pedantic sophistry. Choosing a place, a method, and a time to end one’s own life is suicide. Besides no doctor can predict with certainty how long a patient will live. Treating MAiD as a natural end to life for anorexia sufferers is at best, medical neglect. At worst it is aiding and abetting negligent homicide. Doctors persevere with patients who suffer from cancer or heart disease or diabetes for years. But apparently, Gaudiani has become “Karnak the Magnificent,” who can accurately divine a date of death and assist in administering the final coup de gras. 

As recently as last month, The Denver Post published an op-ed article eviscerating Gaudiani.

I have spoken with at least two parents whose daughters are suffering from anorexia. Each parent was disheartened by Gaudiani’s article. Each had previously respected and looked up to Gaudiani. But that was before. That was before Gaudiani became the perverse proponent of removing that final, tenuous grasp of life to which so many people cling … and that is hope.

Desmond Tutu is credited with saying, “Hope is being able to see there is light despite all of the darkness.” Without question, hope is that one last flickering candle in a room of darkness and despair.

Gaudiani seeks to extinguish that candle.

Imagine being in that dark room of despair, afraid and in pain. One lone candle sitting on a table. Its light, flickering, the wick slowly burning down, the one last vestige of light barely hanging on. You then discern a spectral figure in the room. And suddenly, dark eyes appear, staring at you. You then hear a haunting voice barely above a whisper murmur, “All … hope … is … gone.” You sense, you feel a puff of breath. And then, that last light, all hope, your very life, is extinguished.

Plunging you into permanent darkness.

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