February 15, 2019 – The Texas Medical Board issues a telemedicine license to Jennifer Gaudiani.

February 15, 2022 — The Journal of Eating Disorders publishes Jennifer Gaudiani’s article, “Terminal anorexia nervosa: three cases and proposed clinical characteristics.” (“hereinafter referred to as Terminal Anorexia”)

February 15, 2023 – The first of what may be many medical board complaints will be filed in the State of Texas against Jennifer Gaudiani.

So, how did we get here? And why?

Gaudiani’s article, “Terminal Anorexia” may very well have started a Mental Health Armageddon.

Had Terminal Anorexia simply proposed untested criteria based upon exhaustive study and research and welcomed collaborative input from the mental health community, it perhaps would have been worthy of intellectual debate. But, Gaudiani was not content with that.

When a person is complicit in assisting another human being taking their own life to “prove the viability of an untested protocol” a very clear and unambiguous line is crossed. Especially when that conduct arguably violates criminal laws in 16 Interstate Medical Compact states in which you hold a medical or tele-medicine license.

Doubly so when a good faith argument can be made that you did not even follow your own protocol.

Terminal Anorexia

Gaudiani’s article proposed the following criteria for “terminal anorexia”:

1. A diagnosis of anorexia nervosa;
2. Being age 30 or above;
3. Prior persistent engagement in high-quality, multidisciplinary eating disorder care, and;
4. Consistent, clear expression by the individual (who possesses decision-making capacity) indicating an understanding that further treatment is futile, a choice to stop prolonging life, and an acceptance that death will be the natural outcome of the individual’s anorexia nervosa.

The response from the eating disorder professional community was universal in its condemnation of Gaudiani’s article. This condemnation primarily focused on Gaudiani’s protocols being problematic scientifically and medically.

Gaudiani replied to this condemnation by authoring a second article published in September 2022. In this article, she also attempted to clarify the fourth protocol.

To this end, Gaudiani stated: “Careful determination of decisional capacity is required in each case.” [emphasis added]

Gaudiani also stated, “An individual who wavers in their conviction or expresses different goals to different people is not yet ready to receive the appellation of terminal AN.” [emphasis added]

And now, medical boards in various states will be called upon to determine if Gaudiani violated this fourth criterion, and if so, what the consequences and ramifications should be.

Consistent, clear expression with no wavering

It may be difficult to determine if a patient possesses “consistent, clear expression by the individual (who possesses decision-making capacity) indicating an understanding that further treatment is futile.”

However, what is not difficult is determining when a patient does not have this understanding. And therein lies one of Gaudiani’s major issues which she will need to justify before state medical boards.

Patient No. 2 (Jessica)

In Terminal Anorexia, Gaudiani’s Patient Number 2 (Jessica) is a textbook example of not having this firm conviction and wavering in her decision.

Gaudiani stated in “Terminal Anorexia”:

“Jessica waited several weeks to fill the MAID prescription.” [Red Flag Number 1]

“She then set multiple dates to use it over a couple of months and changed her mind as that date got closer.” [Red Flag Number 2]

Delaying several weeks before filling the MAID prescriptions?

Changing her mind several times before ingesting Gaudiani’s MAID medication?

Doesn’t this conduct define the very essence of wavering in her conviction?

Doesn’t this conduct define the very essence of not having an understanding that further treatment is futile?

Utilizing Gaudiani’s own statements, the only logical conclusion which can be reached is that she prescribed MAID medication to a patient who was not ready to receive the diagnosis of terminal AN. And yet, Gaudiani did nothing to reverse her conduct.

And as a result, a suffering, precious human life was extinguished.

There are other very troubling issues regarding Patient No. 3 (Alyssa) which will not be addressed in this article. Instead, let us look at the harm caused to the living by Terminal Anorexia.

Seeds of doubt, fear and Jane’s Story

Terminal Anorexia’s negative impact on the eating disorder patient population, those who suffered from eating disorders, and those who still suffer was predictable if not inevitable.

An article written by three (3) respected eating disorder professionals states:

“Since … [Gaudiani’s] article was published, we have already had patients approach us to ask if we feel their case is “terminal.

“If providers do not hold the hope for these patients when they can’t do so for themselves, use evidence to guide our recommendations, and acknowledge our own limits in knowing what the future holds for them, what will become of these vulnerable individuals?”

I have become acquainted with Jane Doe. Jane is in her early 50s and has suffered from eating disorders for in excess of thirty (30) years. She has been in a number of treatment centers throughout the United States and has seen various treatment providers consistently during the thirty (30) plus year time period. She is currently undergoing treatment with two, reputable medical doctors specializing in treating eating disorders.

Jane was apprised by third parties about Terminal Anorexia.

This is Jane’s Story in her own words:

“When I first heard of Dr. Gaudiani, her book “Sick Enough” had just come out and my dietitian suggested I read it. She wanted me to understand the medical repercussions of my anorexia and this book was specifically geared towards the medical aspects of eating disorders. I read it and was impressed by the insight she had into anorexia and other eating disorders.

I’m anorexic and have struggled with this disorder for the past 35 years. I have been in and out of treatment centers and inevitably relapsed when I was discharged. It was chronic for me and while there were times when I was able to maintain my weight, I inevitably returned to anorexia when things got rough.

The last four years have been the worst. I almost died twice, once in 2019 and once in 2021.

I had just been discharged from my last treatment stay, when I read the paper Dr. Gaudiani wrote on physician assisted suicide and the steps she had taken to help three eating disorder patients die. I was shocked and at first thought it must be a mistake. I did some research and realized it indeed was accurate.

I find her actions reprehensible. I don’t care how intelligent and put together you may sound, when you are in the depths of your eating disorder, your brain is starved out and not functioning normally. I strongly disagree with her stance that those patients were all in their right mind and capable of making such a serious decision.

My last treatment stay, I was told point blank that I was dying. My response was I didn’t care, I was fine with death and I couldn’t keep living with anorexia dictating my every move. I was ready to die.

The director of the treatment facility I was in went to extreme measures to make sure that didn’t happen. I was too far gone to make the choice to live or die for myself.

All I could think of was here I was, this chronic anorexic, in and out of treatment, feeling hopeless and ready to die. I felt I had nothing left. It scares me to think that had I been Dr. Gaudiani’s patient, I might very well not be here today.

I fit the profile and I’m sure I could have convinced her of my sanity as well. People with severe eating disorders can be very convincing.

Basically, she took away any chance they might have had at turning things around. She didn’t take extreme measures to help them. Her oath as a doctor was first do no harm and she seems to have forgotten that.

Patients who see her in practice need to realize that her take on late stage care may very well end in them no longer being there.

I’m grateful I had people in my corner who were willing to fight for me when I was unable to. Those patients who died with assistance by Gaudiani never had that option. And I find that truly sad.”

Again, eating disorder professionals asked the question, “If providers do not hold the hope for these patients when they can’t do so for themselves, use evidence to guide our recommendations, and acknowledge our own limits in knowing what the future holds for them, what will become of these vulnerable individuals?”

What will become of them? Gaudiani apparently has the answer. And that is, hope will be extinguished. Their lives will be extinguished.

Now it will be up to medical boards in numerous states to determine whether Gaudiani’s answer is acceptable and if not, what ramifications and consequences will be imposed?