This past week, the eating disorder community learned effective June 1, 2023, NEDA was transitioning its helpline program from 4 full time employees to an “artificial intelligence” chatbot designated Tessa. Tessa is expected to become the main support system available through NEDA.

First, Tessa is NOT an artificial intelligence chatbot capable of independent learning and evolution. It is not ChatGPT or Bard. Instead, Tessa is a “rule-based chatbot authoring program.” This type of program is more affordable to develop and can be used without extensive programming experience This approach also represents a reasonable first-line approach to the initial development of a chatbot for a specific purpose.

Having said that, there are obvious deficiencies and drawbacks to programs like Tessa.  Some of the arguments include that that type of program strips away the personal aspect of the support hotline. Another common complaint is a general limitation in understanding and responding appropriately to unanticipated user responses.

The development of mental health prevention chatbots is in its infancy. In the past, NEDA wisely invested money into research of chatbots. In January of 2022, an article entitled, “The Challenges in Designing a Prevention Chatbot for Eating Disorders: Observational Study” was published. That article can be found here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811687/

Since the chatbot is still being refined and polished, perhaps we should ask, why now? And this is where mid-20^th century thinking comes into play.

Labor unions have a long history in the United States as membership reached a peak in the 1940s and 1950s. They were created to protect employee rights and stop exploitation. Unions’ goals are generally enforced through calling a strike (as we see in Hollywood today) and/or collective bargaining.

And yet, for very small companies, and small non-profit organizations like NEDA, unions have the potential to cause catastrophic harm. Nonetheless, in some unknown way, the idea of unionizing came to 4 employees of NEDA.

According to one of the four employees working the helpline, they felt overwhelmed and understaffed. And so, the four decided to unionize. [I wonder where that idea originated?]  

That employee also wrote, “When NEDA refused [to recognize our union], we filed for an election with the National Labor Relations Board and won on March 17.”  And so, they officially became part of Communications Workers (CWA) Local 1101. [The answer to the previous question was just provided.]

Union employees, FOUR union employees… in a very small, non-profit, charitable entity. Four employees with presumably little, if any, legal education and/or experience organizing formal entities like unions.

And so, it would appear as if these four “union” employees want to dictate employment terms to a very small charitable organization. Or do they?

One of the four employees wrote: “Some of us have personally recovered from eating disorders and bring that invaluable experience to our work. All of us came to this job because of our passion for eating disorders and mental health advocacy and our desire to make a difference.” 

Those words don’t sound like they come from a union hack.

The timeline according to these 4 employees was: “After NEDA refused to make meaningful changes, [read, giving in to our union overlords’ demands] we collected a super-majority of signed authorization cards [3 of the 4 employees? How did they even know what constitutes a super-majority under the complex federal and state labor laws] and asked for voluntary recognition of our union around Thanksgiving.”

“When NEDA refused, we filed for an election with the National Labor Relations Board and won on March 17. [Again, how did these 4 employees know this was required?] Then, four days after our election results were certified, all four of us were told we were being let go and replaced by a chatbot.”

They also stated: “Helpline Associates United has filed unfair labor practice charges at the National Labor Relations Board over NEDA management’s refusal to engage in good faith bargaining and their retaliation against workers looking to form a union. [I can’t help but wonder who drafted that language? Language which utilizes legalese.] We plan to keep fighting. While we can think of many instances where technology could benefit us in our work on the Helpline, we’re not going to let our bosses use a chatbot to get rid of our union and our jobs.” [Notice that her statement emphasized “union” before our jobs.]

The NEDA Helpline Associates Union a/k/a those 4 employees, posted this on Twitter:

Those 4 employees end their Twitter post quoting Angela Davis. The Angela Davis who is a well-known eating disorder expert and advocate? Uh… no. It is the Angela Davis who identifies as a “Marxist,” a former leader of the Communist Party USA, a proponent of completely abolishing the prison system. This is the person those 4 employees chose to quote if not emulate. [Did those 4 employees even know who Angela Davis is?]

So, [and I am about to relish the gross and obvious hypocrisy of what I am about to type] … how much money will NEDA need to direct toward the labor complaint filed by these “4 Angela Davis quoting employees,” who instead of finding a collaborative, intelligent path to proceed in the future, chose to embrace a myopic, “dinosaur of the past” unionization believing that is in the best interests of those who suffer from eating disorders?

But then, those 4 employees are not really driving this train are they? In their Twitter post they state … “an unfair labor practice charge has been submitted on our behalf.” That statement clarifies the situation to a great degree.

Starting a union within an organization is a painstaking, difficult process. Submitting that union to a national worker’s union requires meticulous work. Complying with and understanding all aspects of the National Labor Relations Act requires the input of knowledgeable, experienced attorneys.

So, who exactly is giving those 4 misguided, perhaps naïve employees advice? And whose best interest is being pursued by their puppet masters?

Despite what those 4 employees may say, Tessa is a not a union-busting tool. [Again, I wonder from where that language came?] As technology continues to develop, Tessa and other chatbots and artificial intelligence programs represent the future.  

NEDA’s hand was forced not by these 4 employees, per se. But, by the Communications Workers of America Union.

As artificial intelligence and chatbots continue to evolve, improve and grow, this progress will inevitably threaten many jobs currently held by union members. The writer’s strike in Hollywood understands this reality. AI is one of the major issues preventing resolution of that strike.

And perhaps that is the real story.

If the Communications Workers of America Union is successful in obtaining a favorable ruling from the National Labor Relations Board holding that chatbots and artificial intelligence programs cannot be utilized to replace union workers (as is inevitable), the union will inevitably use that ruling as precedence for future, much larger disputes where many thousands of union jobs hang in the balance.

This dispute is not about those 4 naïve employees who are being used as mere pawns by the Communication Workers of America. This dispute is not about NEDA.

This dispute is about the future.

A future in which unions will lose power, prestige, political influence and of course, money.

A future which is inevitable.

“We are sorry that some individuals reading our paper have been upset by the concept that anorexia nervosa has a terminal stage. Our intention is certainly not to cause distress, and Individuals who are adversely affected by exposure to these terms might benefit from opportunities to further explore, clarify, and discuss their reactions to the issues raised by these concepts with their clinicians and others.”

            Jennifer Gaudiani, May 20, 2023

Will Rogers is credited with the quote, “If you find yourself in a hole, stop digging.” For some reason known to only God and broccoli, not only does Jennifer Gaudiani not understand that concept, but she uses an excavator auger to dig her hole as deeply as possible.

Apparently, Gaudiani does not care who she hurts so long as her oversized ego is fed.

On May 20, 2023, with two other authors, Gaudiani paid to have published an article attempting to explain her Protocol of Death. That’s correct. Unless Gaudiani worked out a special arrangement (perhaps a life termination at half price) she had to pay a journal to publish her litany of pablum.

According to that journal, it costs a minimum of 1,340 Sterling pounds which converts to $1,667.83 USD for a publication. Or, about 20 minutes of the amount Gaudiani charges families to buy a “membership fee” for her clinic.

I am embedding her latest manifesto here:

https://jeatdisord.biomedcentral.com/submission-guidelines/fees-and-funding

When you read her self-aggrandizing, self-important continued manifesto of death, you may ask, are there any new statistics in this article? Are there any additional collaborative studies included? Is there any greater insight into why Gaudiani was complicit in the lives of three victims being terminated? Does she explain why her first two victims were terminated before she even wrote her paper setting forth her Protocol of Death? The answers to these questions are obvious.

Gaudiani epitomizes medical system hierarchy and privilege.

The hypocrisy in Gaudiani’s manifesto is epic.  She states:

“First, we fully acknowledge the presence of systems of oppression at work throughout every aspect of eating disorder care and within society that harm both individuals and groups in pervasive ways.”

She then states: “Finally, as we stressed in our initial article, we clearly applaud expanding treatment options and availability, and we strongly advocate for making every effort to provide every single patient every option for treatment and recovery at every phase of their struggles.”

Expanding treatment options and availability?

These hollow words are betrayed by Gaudiani’s own conduct. She speaks of expanding treatment options and availability. So let’s review exactly how she accomplishes this.

Gaudiani’s own website exposes how vacuous her words are. Her fee structure is most instructive.

The fee for Gaudiani’s “expert consultation” is:

“Dr. Gaudiani: $2,500/2-hour expert consultation + pre/post-appointment review/follow-up”

If a patient chooses to join as a “member,” the annual membership fee is $5,000 for Dr. Gaudiani.

Follow-up session fees are as follows:

Dr. Gaudiani: $250/25 min. session + care coordination” [Even that statistic is deceptive. How many ethical therapists conduct 25 minute sessions? Maybe Gaudiani is so erudite, she can accomplish in 1/2 the time it takes other counselors one hour to accomplish. Obviously, Gaudiani can “terminate” eating disorders faster than anyone at home or abroad! Make no mistake. Gaudiani’s hourly charge is $600.00.]

What about health insurance?

Not only does Gaudiani NOT accept insurance, she will not even submit claims directly to insurance companies.

And as for Medicare/Medicaid?

Not a chance.

What about consulting with your primary care physician?

Sorry! Not … oh wait. She will do that. At the mere cost to every family of … $1,000.00 per hour.

In her manifesto, she stated, “We would like to emphasize that the motivation for our articles was to bring attention to the importance of considering end-of-life care issues for patients with anorexia nervosa, not to stigmatize, or develop hierarchies, or privilege some patients over others.”

For those who are suffering who cannot afford Gaudiani’s outrageous price structure?  You are the broken eggs making the omelet. You do not have access to Gaudiani’s so-called “clinic membership.” Gaudiani perpetuates the very definition of white, elitist, exclusionary, hierarchal medical and mental health care. Of course, she does not want to discuss those issues. Since she is the very essence of this elitist, medical bias.

Her fee structure, her refusal to accept Medicare and Medicaid, her refusal to accept insurance is the very essence of privilege and treating some patients over others. As for the poor?  Those in the minority communities? Well, her Protocol of Death may be just what you are looking for.

In fact, the only price point missing on Gaudiani’s website is the cost to participate in her Protocol of Death. Or is that the only service she offers for free?

HAES misaligned.

Gaudiani’s hypocrisy started long before the most recent revelations. For years, she has positioned herself as a HAES informed provider. Podcasts have stated, “She [Gaudiani] is working hard to change the way medical care is practiced for those in larger bodies. She shared her story of how she became HAES-aligned…” Another podcast stated, “Dr. Jennifer Gaudiani, author of the book, Sick Enough, has made weight inclusive medical care a priority at her Denver based telemedicine clinic and she shares her ideas for why doctors must act to eradicate weight stigma on this episode.”

Weight inclusivity. HAES aligned. Certainly, Gaudiani took those noble goals and made it a priority to be inclusive in her own hiring practices. So, let’s take a look at her executive employees.

Jennifer Gaudiani … non-obese, white female.

Sarah-Ashley Robbins, M.D. … non-obese white female

Aimee Lischke, M.D. … non-obese white female

Aimee Becker, Chief Operating Officer, non-obese white female

Meghan Eliopulos, Chief Marketing Officer, non-obese white female

Abby Brockman, RN … non-obese white female

Krista Erickson, Director of Intake … non-obese white female

Camille Vander Veen, Clinic Manager … non-obese white female

Anupama Das, MD … non-obese Indian nationality

Of the 9 employees listed on her website, 8 are non-obese white women.

The ASDAH, which owns the HAES trademark, drummed Lindo Bacon out of its organization for far less than this.

In short, Gaudiani may talk about being HAES aligned and being weight inclusive. But these words are hollow since she does not remotely practice diversity among her own executive team.

Perhaps what Gaudiani should have said was she was HAES aligned and weight inclusive (except in her hiring practices) as long as you can afford her outrageously high fees.

Taking Clueless to an Epic Level

The very first sentence of the May 20 article demonstrates the absolute tone-deaf nature of an egomaniac. “We are pleased that the concept of terminal anorexia nervosa is being considered in serious discussion.”

Gaudiani is pleased that the entire eating disorder community has aligned against her? Gaudiani is pleased that there are at least 5 articles from around the world which rip to shreds her Protocol of Death? Gaudiani is pleased that no reputable eating disorder professional will publicly stand with her and her little team? Gaudiani is pleased that her voice is the only voice in favor of her Protocol of Death?

Is that considered serious discussions? Clueless… absolutely clueless.

The Knife to the Heart

Gaudiani’s true damaging words, the words she boldly and unapologetically wrote included, “We are sorry that some individuals reading our paper have been upset by the concept that anorexia nervosa has a terminal stage. Our intention is certainly not to cause distress, and Individuals who are adversely affected by exposure to these terms might benefit from opportunities to further explore, clarify, and discuss their reactions to the issues raised by these concepts with their clinicians and others.”

So, if her Protocol of Death hurt you, or made you upset … tough! Go tell it to your therapist. Or, if you can afford her outrageous fees, you can come to her. As long as you have enough Mr. Green, Yankee dollars, sawbucks.

But that is not the worst. Gaudiani stated, “At the end they may have agonal breathing, and then stop breathing. Their hearts stop. They die. They terminate.” 

They terminate.

Good Lord. What cold, uncaring, unfeeling words from a superficial, egomaniacal hypocrite.

They terminate.

They terminate.

Our beloved children terminate.

Hey Everyone! My beloved daughter Morgan was terminated at 11:31 p.m. on October 30, 2016! Hasta la vista baby!

Why would any family go to the Gaudiani Clinic, pay her very high fees, (presumably in advance) while knowing that its founder refers to the most heart wrenching pain a parent can experience, the greatest heart ache imaginable … as your child terminating?

And that same person has the audacity to also say through her then attorney, “Let me begin by saying that Dr. Gaudiani and I both understand the overwhelming and lasting grief you must feel from the loss of your daughter to anorexia nervosa.”

The fact that Gaudiani uses the word “terminate” to describe the most precious thing you hold dear being taken from this existence, while at the same time stating she “understands the overwhelming and lasting grief” a parent feels when your child dies as a result of anorexia nervosa is the clearest example of the darkest of hearts and the darkest of souls.

They terminate.

They terminate.

Perhaps, regarding termination, the only thing that will be terminated is Gaudiani’s Clinic… as complaints to every state board in which she is licensed to practice are being made. And those complaints are being made. As more families come to the understanding that they will not abide their children being terminated.

Because surely, being terminated is the cruelest cancellation of them all.

For decades, scholars, supreme court justices, medical and mental health organizations, state and federal legislatures and governmental entities have pondered the complex issue of physician assisted suicide. This issue touches the very core of our existence. Life and death. That which we hold most dear.

And yet apparently, one person believes that she possesses a wisdom, insight and understanding far greater than the collective attributes of the aforementioned entities. One person who created a Protocol of Death. A protocol which much surely provide answers to the medical, moral, legal, philosophical and economic issues which have befuddled our greatest minds since time immemorial. Or not.

Gaudiani Creates the Protocol of Death

In February 2022, an article written by Dr. Jennifer Gaudiani (“Gaudiani”) was published. She had manufactured Physician Assisted Suicide for Severe and Enduring Anorexia. She called it, “Terminal Anorexia.” It can just as accurately be called, “The Protocol of Death.” This protocol is rather parochial. It consists of 4 parts:

1. A diagnosis of anorexia nervosa.
2. Age of 30 or older.
3. Prior persistent engagement in high-quality, multidisciplinary eating disorder care.
4. Consistent, clear expression by an individual who possesses decision-making capacity that they understand further treatment to be futile, they choose to stop trying to prolong their lives, and they accept that death will be the natural outcome. 

That’s it. That is the Protocol of Death.

The Community’s Response

A number of academic articles were published which strongly refuted Gaudiani’s protocol. These articles were professional, thorough and scholarly. However, these articles did not address the reality that three souls were dead. A human toll was paid. And lives were relegated to mere words on paper.

From an academic perspective, these articles illuminate the following, EIGHTEEN (18) deficiencies in Gaudiani’s Protocol of Death:

1. Gaudiani’s framework for “terminal” AN necessarily assumes personal privilege, discounts systemic oppression, and fails to consider the interaction between diagnoses and perceived hierarchies across the full spectrum of eating disorders (“EDs”);

2. There are no generally accepted standards of care for treating eating disorders;

3. The proposed requirement for age restriction over 30 raises several concerns. First, it would treat equally those with illness onset at 16 or 26 (or 36). If duration is relevant, those scenarios are clearly very different. Second, it cannot account for the myriad of different courses of illness, ability, and disability encountered among those with AN. Third, long-term follow-up data show that recovery from AN can occur after a long duration of illness and that this may happen for a substantial number of people; 

4. The industry lacks adequately powered research designs with meaningful follow-up periods—and the predictors identified from such studies requiring replication. For applicability to the care of those with longstanding AN, data on use as secondary treatments is essential to make rigorous decisions about futility of treatment;

5. Two of the patients described by Gaudiani were offered her Protocol of Death without ever receiving adequate inpatient specialty care; 
6. Gaudiani did not account for the interplay between treatment access, systemic oppression, iatrogenic harm, and conceptualizations of futility;

7. Inpatient, residential, partial hospitalization, and intensive outpatient programs for EDs in the United States are typically not individualized, are often administered within institutions controlled by private equity, and are beholden to insurance company’s interpretations of progress, which can impede an individual’s full potential for healing;

8. While some therapeutic modalities utilized in ED treatment are evidence-based, there is a lack of comprehensive, impartial, and long-term research demonstrating the efficacy of the way these modalities are implemented in ED treatment settings;

9. Little evidence exists regarding the effectiveness of higher levels of care for treating members of communities that are underrepresented in ED care and ED research;

10. Bias in clinician training, lack of necessary competencies, distressing milieu dynamics, and one-size-fits-all treatment modalities can result in treatment that is intolerable which impedes the potential for meaningful healing;

11. Individuals who have not previously had access to “good quality” treatment will be labeled as “terminal” and therefore be less able to access quality treatment in the future, as the terminal prognosis would be seen to render further treatment futile;

12. An estimated 8 out of 10 or more individuals with EDs never receive care at any level so access to “a full course of treatment” is a privilege, not the norm;

13. Those who do not have access to substantial wealth face barriers in accessing the range of ED care which is often medically indicated; 

14. ED diagnosis is typically delayed among people of color and there is a lack of culturally relevant ED care, as ED treatment settings are overwhelmingly white, both visually and culturally;

15. Due to the complex entanglement of co-occurring disorders and EDs, other psychiatric disorders may interfere with remission of eating disorder symptomatology and negatively impact long-term healing if left untreated;

16. Gaudiani is ultimately presenting a largely affective definition of terminality, rather than one that is medically substantiated, which serves to further stereotypes about individuals with AN and reaffirm a harmful hierarchy of Eds;
17. Gaudiani failed to provide adequate evidence that individuals with: (A) (a diagnosis of AN) and (B) (age 30 or older) are more likely to die from their AN within 6 months of ceasing recovery-oriented behaviors;

18. The claim that death will inevitably result within 6 months without active recovery work is unsubstantiated given that deaths from medical complications of AN may be abrupt and unpredictable, since some individuals live with AN for decades and many individuals recover well after ten years of illness.

To characterize Gaudiani’s Protocol of Death as a train wreck of Biblical proportions would be charitable.

Additional Issues of Concern

And yet, additional issues exist which raise greater concerns about Gaudiani and her Protocol of Death. In podcasts after publication, Gaudiani admitted the following:

“It’s not really mine to judge whether they wanted life enough or checked every single box perfectly because it isn’t a textbook, it’s a life. It’s a human who finds life intolerable and so my job then is not to be judge but rather I felt like I used every ounce of my expertise to try to make life sustainable for this human, I then accept their final determination they can no longer fight.”

“Physician assisted suicide, if it exists, is illegal everywhere and I would never in a million years take part in it. It is illegal. It is not a thing.”

“My physical exam skills are only ok. I’m not super great at knowing the literature.”

“With regard to decision making authority, as a non-psychiatrist, I don’t know all the details that go into that.”

Unreal.

Gaudiani is an internist who was rejected by 25 medical schools to which she applied. By her own admissions she; “is not super great at knowing the literature” and “with regard to decision making authority, as a non-psychiatrist, does not know all the details that go into that.” And yet, she created her Protocol of Death, a protocol that is designed to accomplish one thing and one thing alone … the taking of a human life.

That very same doctor, who in a correspondence sent to me through her then attorney stated, “Let me begin by saying that Dr. Gaudiani and I both understand the overwhelming and lasting grief you must feel from the loss of your daughter to anorexia nervosa.”

My response? No, doctor, you do not understand. Unless you have had a child taken you could not possibly understand. It is far beyond whatever vapid comprehension you may claim to have. It is beyond your worst nightmare. But the fact that your ego leads you to believe that you do understand gives insight into, not who but what, you truly are.

But there is even more.

Gaudiani’s three victims ‘coincidentally’ happened to fit all of the criteria for her Protocol of Death. Or did they?

Obviously, these three victims were former patients of Gaudiani. Three victims who presumably did not know each other.  So, how could these three victims know about Gaudiani’s Protocol of Death since it was not published until after they died? Did each of them separately discover Gaudiani had created a Protocol of Death and that they coincidentally satisfied her criteria? In fact, based upon what Gaudiani stated in the podcast, “Death with Dignity,” two of the three victims died before she even wrote her article!

From the podcast, “Death with Dignity” we glean additional information. In that podcast, Gaudiani stated, “I think, I think … that based upon the two last patients I cared for in this situation, and you, I need to write a paper about this.”It is quite telling that Gaudiani did not state, “I need to contact the most respected, intelligent, experienced clinicians, psychiatrists and research professionals in the United States so that we may address this growing problem collaboratively.” Instead she stated, “I need to write a paper about this.”

Since logic dictates that victims numbered 1 and 2 died before Gaudiani even wrote her paper, what criteria, if any, did Gaudiani rely upon in helping victims 1 and 2 to their final “reward?” Or, did she make up criteria after the fact?

There are other troubling issues as well. Are we not justified in asking, how many other victims did Gaudiani induce to if nothing else, sign a Do Not Resuscitate document? How many others did she induce to go to hospice care? Are there any former patients/victims under the age of 30 years old whom Gaudiani recommended DNR or hospice?

Because … those people exist. Some have survived. And they no longer fear. They do not fear intimidation. They do not fear expected retaliation. They do not fear receiving a letter from an attorney employed by Gaudiani. They do not fear further abuse. They no longer fear you!

For it is their time now. And through various medical boards, state agencies, federal agencies and the legal system, their voices will be heard.

It is time for someone else to be afraid.

It is time for other people’s stories to be told.

And for the eating disorder and mental health community, the questions will be asked and you will be put on the spot … it is long past time for you to decide.

Do you stand with the living?

Or do you lie with the dead?

In 2010, the American Psychiatric Association initiated a process for developing clinical practice guidelines. The following year, it adopted a new guideline development process. Steps in the development process include:

1. Establishing transparency;
2. Managing conflicts of interest;
3. Composing work groups;
4. Using systematic reviews of evidence;
5. Articulating and rating recommendations in guidelines;
6. Obtaining external review, and;
7. Updating.

Collecting evidence, reviewing it and interpreting it is of particular importance. That is because conclusive evidence rarely exists for mental health-based healthcare procedures.

Nonetheless, the conclusiveness of evidence is critically important since often times, the guidelines are not just to recommend the most strongly supported treatments for a given illness, but more commonly, the evidence needs to be interpreted into a clinical, public health policy, or payment context. Since guidelines can have broad applications, legal interpretations and advisory opinions are also important and should be obtained.

Ordinarily issued by third-party organizations, guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature.

So, what if this process is ignored?

What consequences exist if a rogue doctor decides to ignore methodical processes and simply create and implement her own guidelines? Guidelines about which the entire eating disorder community strongly disagrees. Guidelines pertaining to the taking of another person’s life. That is, Physician Assisted Suicide (“PAS”) [or Medical Aid in Dying a/k/a MAiD].

PAS recently has taken a more significant place in the consciousness of the mental health community.

PAS in Canada

In 2021, Canada’s Parliament determined that those Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria for MAiD, would not be eligible for MAiD until March 17, 2023.

The original two-year temporary exclusion was put in place to provide additional time to study how MAiD can safely be provided and to ensure appropriate safeguards are in place to protect those persons who suffer from mental illness.

The Government of Canada established an Expert Panel on MAiD and Mental Illness. This Panel was tasked with making recommendations on protocols, guidance and safeguards applicable to requests for MAiD by persons who have a mental illness.

In December 2022, the Government of Canada announced that it would extend the original two-year exclusion of eligibility for an additional period of time until 2024.

This extension is intended to allow additional time to complete and disseminate key resources currently under development for clinicians and other health care system partners to address these more complex MAiD requests. The extension will also provide more time to consider the parliamentary Special Joint Committee on MAiD’s interim and final reports.

Imagine … a thoroughly collaborative report. Government resources. In depth study by third parties. Review of evidence-based standards. Open to comments from persons in the mental health community. Establishing protocols and safeguards. And understandably so.

After all, we are addressing our very existence. Your life. Your precious life.

PAS for Severe and Enduring Anorexia Nervosa ?

Now imagine a PAS protocol proposed for Severe and Enduring Anorexia Nervosa. Surely this would require years of study. Our greatest minds collaborating on this protocol. Medical clinicians. Research professionals. Invested leaders in organizations. Research. Study. Legal opinions. Collaboration with spiritual leaders. Interaction with other mental health professionals. Grants. Funding from federal and state levels of government. Comments from interested families and patients.

Life and Death.

All that we are. All that we ever have been. All that we ever will be. Our love. Our laughter. Our hope. Our dreams. Everything that makes each of us special and unique.

But, what if?

There were no collaborative reports. No government resources. No in-depth studies by third parties. Little to no review of evidence-based standards in part, because there ARE NO generally accepted evidence-based standards. Not being open to comments from persons in the mental health community. Not establishing effective protocols nor safeguards. No independent peer review.

The frightening hypotheticals in the aforementioned paragraph are no longer hypothetical … they are now a grim reality.

Only, it gets worse.

Imagine ignoring American Medical Association Code of Ethics Opinion 5.7 on Physician Assisted Suicide which states in part: “Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

Imagine ignoring the AMA’s Council on Ethics and Judicial Affairs (CEJA) Report on Physician Assisted Suicide which once again concluded that physician assisted suicide is fundamentally incompatible with the physician’s role as healer and stated, “Scholars have cited the prospect that boundaries will be eroded, and practice will be extended beyond competent, terminally ill adult patients; to patients with psychiatric disorders, children; or that criteria will be broadened beyond physical suffering to encompass existential suffering.”

Imagine violating criminal laws pertaining to assisted suicide in fifteen (15) states in which you hold a medical or telemedicine license.

Imagine engaging in unprofessional or dishonorable conduct likely to deceive or defraud the public because that physician arguably committed acts which violate criminal laws in 15 different states.

Imagine ignoring the reality that your “Frankenstein-like” protocol creates an unregulated zone, which allows a free-for-all with no independent or public oversight into whether people who die by physician-assisted suicide are actually close to death, have a treatable mental disorder, are coerced into death by another person, or lack feasible alternatives.

Imagine having an ego which leads you to naively believe you can devise an end-of-life protocol that foreign governments, state entities, international and domestic organizations and conglomerations of academic professionals and medical clinicians have struggled with for decades.

Now, imagine that same person was rejected by 25 of the 26 medical schools to which she applied.

Imagine that in podcasts after an article is published evidencing that you had in fact, committed all of the above-referenced conduct, you admit:

“With regard to decision making authority [of the patient], as a non-psychiatrist, I don’t know all the details that go into that.”

“My physical exam skills are only ok. I’m not super great at knowing the literature.”

“Each one of these patients wanted to live. They passionately wanted to be alive. And to use their gifts for the good of others.”

“It’s not really mine to judge whether they wanted life enough or checked every single box perfectly because it isn’t a textbook, it’s a life. It’s a human who finds life intolerable and so my job then is not to be judge but rather I felt like I used every ounce of my expertise to try to make life sustainable for this human, I then accept their final determination they can no longer fight.”

That is the tragic, unfortunate reality which exists today.

And life is expected to go on … at least for those who are not deemed beyond saving by that one person.

Clinical doctors, research professionals and advocates used the following words to describe that person’s conduct, “reprehensible, appalling, irresponsible and horrifying.” Naturally, strong 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.

Until now.

A recent lawsuit filed in federal court in California has the potential to turn on its head the issue of Physician Assisted Suicide on a nation-wide basis.

In addition, there is the specter of investigations currently being conducted by state medical boards into that person.

Consequences are on the horizon. As they surely must be.

These matters, the lawsuit and its possible ramifications will be discussed in Part Two.

Artificial intelligence platforms are here. Not yet the all-knowing, self-aware, evil Skynet shown in the 1984 movie, The Terminator, Ai is certainly here to stay. And even if a Congressionally mandated six (6) month stay in development is approved, which is unlikely, there will be no impact on Ai’s continued development.

Also, make no mistake. Ai is in its infancy. These platforms are the “three wheeled vehicles powered by a gas engine” patented by Carl Benz in 1886. This was the very first generation of what was to become the automobile. And except for the wheels and sometimes, a gas-powered engine, Carl Benz’s invention has as much in common with today’s modern automobiles as the current Ai platforms will have to that which will exist in five (5) years.

I call the Ai platform I utilize “Cicero.” It is named after one of the greatest authors, politicians and statesmen ancient Rome ever knew. So on a beautiful Saturday morning, I spent a brief amount of time with Cicero asking questions about Ai platforms, mental health, eating disorders and insurance companies.

This is our conversation … word for word …

“How are artificial intelligence software programs going to impact insurance companies’ mental health claims?”

Artificial intelligence software programs have the potential to significantly impact insurance companies’ handling of mental health claims. Here are some ways that AI could affect the industry:

1. Improved Claims Processing: AI-powered claims processing systems can analyze claims data and identify potential fraud, errors, or discrepancies. This can help insurers process mental health claims more efficiently and accurately, reducing the likelihood of delays or denied claims.
2. Better Risk Assessment: AI algorithms can analyze large amounts of data to identify patterns and predict risks associated with mental health claims. This can help insurers better understand the potential costs associated with mental health claims and adjust their pricing and coverage accordingly.
3. Personalized Treatment: AI algorithms can help insurers recommend personalized treatments for mental health issues based on the patient’s medical history and other data. This can help insurers provide more effective and efficient treatments for mental health claims, improving patient outcomes and reducing costs.
4. Early Intervention: AI can help insurers identify mental health issues early and recommend appropriate interventions to prevent the condition from worsening. This can help insurers reduce the cost of claims associated with mental health conditions by preventing more severe conditions from developing.

Overall, AI has the potential to help insurers process mental health claims more efficiently and accurately, reduce costs, and improve patient outcomes. However, it’s important to note that AI is not a panacea and should be used in conjunction with human judgment and oversight to ensure the best possible outcomes for both insurers and patients.

“Elaborate on your last answer.”

While AI has the potential to improve the handling of mental health claims by insurance companies, it’s important to note that it should not be seen as a replacement for human judgment and oversight. Here are some reasons why:

1. Lack of Empathy: AI algorithms are based on data and statistical models, which may not always take into account the unique circumstances of a patient’s mental health condition. Human empathy is crucial in understanding and responding to the emotional and psychological aspects of mental health, which cannot be replicated by AI.
2. Risk of Bias: AI algorithms may be influenced by the data they are trained on, which may contain biases and perpetuate existing inequalities. Human oversight is necessary to ensure that AI is not inadvertently perpetuating bias and discrimination in the handling of mental health claims.
3. Complexity of Mental Health Conditions: Mental health conditions can be complex and multifaceted, requiring a nuanced understanding of the patient’s medical history and personal circumstances. While AI can assist in identifying patterns and predicting risks, human judgment and expertise are necessary in developing personalized treatment plans that address the unique needs of each patient.
4. Legal and Ethical Considerations: The handling of mental health claims by insurance companies is subject to legal and ethical considerations, such as patient confidentiality and privacy. Human oversight is necessary to ensure that these considerations are upheld and that AI is being used in a responsible and ethical manner.

In summary, while AI has the potential to improve the handling of mental health claims by insurance companies, it should be used in conjunction with human judgment and oversight to ensure that the unique needs of each patient are being addressed in a responsible and empathetic manner.

“What cost savings will health insurance companies have by utilizing artificial intelligence programs?”

Artificial intelligence (AI) has the potential to generate significant cost savings for health insurance companies. Here are some ways that AI can help insurers reduce costs:

1. Improved Claims Processing: AI-powered claims processing systems can analyze claims data and identify potential fraud, errors, or discrepancies. This can help insurers process claims more efficiently and accurately, reducing the likelihood of delays or denied claims. By reducing errors and fraud, insurers can save money by avoiding unnecessary payouts.
2. Better Risk Assessment: AI algorithms can analyze large amounts of data to identify patterns and predict risks associated with certain health conditions. This can help insurers better understand the potential costs associated with different health conditions and adjust their pricing and coverage accordingly. By pricing policies more accurately, insurers can reduce the likelihood of overpaying or underpricing policies, which can lead to increased profitability.
3. Personalized Treatment: AI algorithms can help insurers recommend personalized treatments based on a patient’s medical history and other data. This can help insurers provide more effective and efficient treatments, reducing the cost of care and improving patient outcomes.
4. Early Intervention: AI can help insurers identify health issues early and recommend appropriate interventions to prevent the condition from worsening. This can help insurers reduce the cost of claims by preventing more severe conditions from developing, which can be more expensive to treat.

Overall, by utilizing AI, health insurance companies can improve their operational efficiency, reduce errors and fraud, improve risk assessment, and provide more personalized and effective care, leading to cost savings and increased profitability. However, it’s important to note that implementing AI programs can involve significant upfront costs, including investment in technology and employee training.

“How will artificial intelligence programs replace human beings in the processing of claims for mental health insurance companies?”

Artificial intelligence (AI) programs are unlikely to completely replace human beings in the processing of claims for mental health insurance companies. While AI can assist in automating certain tasks and processes, human judgment and expertise are still necessary to ensure that claims are processed accurately and fairly. Here are some reasons why:

1. Complexity of Mental Health Conditions: Mental health conditions can be complex and multifaceted, requiring a nuanced understanding of the patient’s medical history and personal circumstances. While AI can assist in identifying patterns and predicting risks, human expertise is necessary in developing personalized treatment plans that address the unique needs of each patient.
2. Legal and Ethical Considerations: The handling of mental health claims by insurance companies is subject to legal and ethical considerations, such as patient confidentiality and privacy. Human oversight is necessary to ensure that these considerations are upheld and that AI is being used in a responsible and ethical manner.
3. Empathy and Emotional Intelligence: Mental health claims involve emotional and psychological aspects that cannot be replicated by AI. Human empathy and emotional intelligence are crucial in understanding and responding to the unique needs of each patient.
4. Human Judgment and Oversight: While AI can assist in identifying potential fraud or errors in claims data, human judgment and oversight are necessary to ensure that claims are processed accurately and fairly. Humans can also provide oversight to ensure that AI is not perpetuating bias or discrimination in the handling of mental health claims.

In summary, while AI can assist in the processing of mental health claims for insurance companies, it is unlikely to completely replace human beings. Human judgment, expertise, empathy, and oversight are still necessary to ensure that claims are processed accurately and fairly, and that the unique needs of each patient are being addressed in a responsible and ethical manner.

“How much cost savings will patients have by health insurance companies using AI platforms?”

It’s difficult to estimate the exact amount of cost savings that patients will have by health insurance companies using AI platforms, as the impact will depend on a variety of factors such as the specific AI applications being used, the patient population being served, and the overall healthcare landscape. However, there are several ways in which AI could potentially lead to cost savings for patients:

1. Lower Premiums: As health insurance companies become more accurate in pricing policies using AI-powered risk assessments, patients may be able to access more affordable health insurance plans. This could lead to lower monthly premiums and overall healthcare costs for patients.
2. Reduced Out-of-Pocket Costs: AI can help insurers identify opportunities for more efficient care delivery, such as earlier interventions or more targeted treatments. This could lead to reduced out-of-pocket costs for patients, such as lower copays or deductibles.
3. Preventative Care: AI-powered systems can help insurers identify potential health issues before they become more serious, enabling earlier interventions and preventive care. This could lead to cost savings for patients by avoiding more costly treatments or hospitalizations later on.
4. Reduced Administrative Costs: By automating certain administrative tasks such as claims processing and fraud detection, AI can help insurers reduce overhead costs. This could lead to lower administrative costs for insurers, which could be passed on to patients in the form of reduced premiums or out-of-pocket costs.

Overall, the use of AI by health insurance companies has the potential to lead to cost savings for patients. While the exact impact will depend on a variety of factors, the potential for reduced premiums, out-of-pocket costs, and more efficient care delivery could make healthcare more affordable and accessible to a wider range of people.

“How can AI platforms utilized by health insurance companies counteract the inherent greed of the human owners of those companies?”

AI platforms utilized by health insurance companies are tools that can help improve efficiency, reduce costs, and improve the quality of care for patients. However, it is important to recognize that the use of AI does not directly address the issue of greed or other ethical concerns related to the human owners of these companies.

One way that AI can potentially help counteract the negative effects of greed is by increasing transparency in the healthcare system. By providing more data and insights into healthcare spending and outcomes, AI can help identify areas where costs can be reduced and quality of care can be improved. This can help hold health insurance companies accountable and create a more fair and equitable system.

Additionally, AI can potentially help reduce fraud and abuse within the healthcare system. By analyzing large amounts of data and identifying patterns of fraudulent behavior, AI-powered systems can help prevent fraudulent claims and other forms of abuse. This can help reduce costs and improve the overall integrity of the healthcare system.

Finally, it is important to recognize that the use of AI alone is not a panacea for all the problems within the healthcare industry. Ethical considerations must be taken into account when developing and implementing these systems, and human oversight is essential to ensure that AI is being used in a responsible and ethical manner.

In summary, while AI platforms can help improve the efficiency and transparency of the healthcare system, they alone cannot fully counteract the inherent greed of human owners of health insurance companies. It is important to consider the ethical implications of their use and to implement oversight mechanisms to ensure that these systems are being used in a responsible and ethical manner.

“How will AI platforms utilized by health insurance companies replace or reduce the dependence on lived experience endured by human patients?”

AI platforms utilized by health insurance companies are not intended to replace or reduce the dependence on the lived experience of human patients. In fact, one of the primary goals of AI in healthcare is to enhance and complement the human experience of healthcare, rather than replace it.

While AI can help process large amounts of data and identify patterns that may be difficult for humans to detect, it cannot replace the unique perspective and experience of individual patients. AI can help inform clinical decision-making by providing additional data and insights, but ultimately it is up to the patient and their healthcare providers to make decisions about their care based on their individual needs, preferences, and experiences.

In some cases, AI may even help improve the patient experience by enabling more personalized and targeted care. For example, AI-powered systems can help identify patients who are at higher risk for certain health conditions or who may benefit from particular interventions, enabling more proactive and personalized care.

Overall, AI platforms utilized by health insurance companies are not intended to replace the lived experience of human patients, but rather to complement and enhance it. By providing additional data and insights, AI can help improve the quality of care and enable more personalized and effective healthcare delivery.

“How will AI platforms become involved in medical aid in dying for mental health issues in the United States?”

Medical aid in dying, also known as assisted suicide or voluntary euthanasia, is currently legal in only a few states in the United States and is typically limited to patients with terminal illnesses. As such, it is unlikely that AI platforms will become directly involved in medical aid in dying for mental health issues in the United States, as this is currently outside the scope of the law.

However, AI platforms could potentially be involved in other aspects of mental healthcare, such as identifying patients who may benefit from interventions to improve their quality of life or identifying patterns of mental illness and potential risk factors. AI-powered systems could also be used to help identify patients who may be at higher risk for suicide and provide early interventions to prevent self-harm.

It is important to note that the use of AI in mental healthcare must be carefully considered and implemented in an ethical and responsible manner. AI systems must be trained on diverse and representative datasets to ensure that they do not perpetuate bias or exacerbate existing inequalities in healthcare. Additionally, human oversight and involvement are essential to ensure that AI is being used in a responsible and ethical manner and that patient autonomy and privacy are respected.

“How can AI platforms help reduce the recidivism rate for eating disorders?”

AI platforms can potentially help reduce the recidivism rate for eating disorders by providing personalized and targeted interventions to patients. Eating disorders are complex conditions that are influenced by a variety of biological, psychological, and social factors. As such, effective treatment often requires a personalized and multifaceted approach.

AI-powered systems can help identify patterns and risk factors associated with eating disorders, enabling more targeted interventions. For example, AI can be used to analyze large datasets of patient information to identify factors that are associated with increased risk of relapse or poor treatment outcomes. This information can then be used to tailor treatment plans to each patient’s individual needs and characteristics.

AI can also be used to monitor patients remotely and provide real-time feedback and support. For example, AI-powered chatbots can be used to provide daily check-ins and provide patients with coping strategies and other support. This can help patients stay engaged in treatment and avoid relapse.

Finally, AI can be used to improve access to care for patients with eating disorders. This can include identifying patients who are at high risk of developing eating disorders and providing early interventions, as well as improving access to treatment for underserved populations.

Overall, AI platforms have the potential to help reduce the recidivism rate for eating disorders by providing personalized and targeted interventions, monitoring patients remotely, and improving access to care. However, it is important to note that the use of AI in healthcare must be carefully considered and implemented in an ethical and responsible manner and should be used in conjunction with human oversight and involvement to ensure that patient autonomy and privacy are respected.

End of discussion.

Of great concern is the reality that the answers given to questions asking about how artificial intelligence platforms are going to impact insurance companies’ mental health claims and the cost savings resulting for insurance companies are nearly identical.

Of greater concern is the fact that Ai will be dependent on the information uploaded into its system. Since behavioral health insurance companies can upload any information it chooses, i.e., its own treatment guidelines, health information regarding hundreds of thousands, if not millions of its insureds, legal caselaw which can be interpreted to support insurance companies’ guidelines and past claims decisions, the bias in those Ai programs will likely surpass the bias we see today.

Perhaps the greatest concern is … insurance companies are already utilizing Ai platforms in their treatment decisions. Some levels of employees are already being replaced. THAT is the reality.

And, the insurance companies will have what they crave … plausible deniability.

In prior articles, I have written about the Wit, et al v. United Behavioral Healthcare case. However, I may not have clearly explained why this case is so significant and will, on a national level, impact mental health care treatment.

So, why is the Wit case significant? Whatever final judgment is rendered in Wit will either have incredibly revolutionary or in the alternative, dangerous nationwide consequences.

Virtually every health plan in America works like the health benefit plans at issue in Wit.

Virtually every insurer in America uses commercial guidelines in its medical-necessity reviews.

Dozens of organizations, like the American Medical Association and the American Psychiatric Association filed explanatory briefs in Wit. They explained to the court system that allowing insurers to use their own internal guidelines which deviate from the medical community’s standards will have an enormous and devastating impact. Generally accepted standards of care will have little meaning if insurers are allowed to impose their guidelines upon their insureds especially when those guidelines were filtered through their own finance and accounting departments.

The attorneys representing Wit explained to the courts that the district court’s initial decision has been hailed as the “Brown v. Board of Education” decision for the mental health movement and that it is “one of the most important and most thorough rulings ever issued against an insurance company.”

To briefly recap, a federal magistrate judge certified the case as a class action proceeding thereby impacting as many as 50,000 insureds of UBH. On March 5, 2019, that judge issued a sweeping ruling holding that UBH on a class wide basis, violated its fiduciary duties to its insureds, improperly ran its treatment guidelines through its finance and accounting departments, and improperly denied payment for necessary treatment. The ramifications and remedies for this bad faith conduct were then yet to be determined.

Shortly thereafter, the consequences for UBH’s bad faith conduct were established.

UBH was ordered to reprocess 67,000 claims it wrongfully denied for 50,000 people from 2011 to 2017. The district court entered a permanent injunction against UBH requiring UBH to evaluate claims using independent guidelines developed by professional mental health associations instead of its internal guidelines, which it had previously used to protect its bottom line. The injunction also required training of UBH personnel in the use of court-ordered medical necessity criteria.

As expected, UBH appealed the decision to the 9^th Circuit Court of Appeals. In 2022, after hearing oral arguments, a three (3) judge panel issued a shockingly curt opinion reversing the district court’s judgment. This short ruling was designated “not for publication” (therefore, should not have been used as precedent in other cases), was dismissive and could have been the death knell for hundreds of thousands of persons suffering from mental illnesses.

Because Wit’s attorneys petitioned for a rehearing, in January of 2023, the three (3) judge panel threw out their first opinion and published a longer, more substantial opinion. On the positive side, it affirmed some significant findings from the trial court, including in particular, that UBH breached its fiduciary duties by putting its own financial interests above those of its insureds when adopting and applying its internal guidelines. This finding reopens the door for significant injunctive and declaratory relief. 

At the same time, other key holdings worsen the ability for private parties to seek payment for medical care. In addition, the opinion could result in ERISA Administrators using overly restrictive guidelines designed to save money and not lives.

In response, Wit’s attorneys again petitioned for a rehearing or to have all 29 judges on the 9^th Circuit hear oral arguments and issue a new opinion. If that fails, the US Supreme Court could decide all issues.

Wit’s attorneys assertively pointed out that the three (3) judge panel’s decision is disastrously wrong and will result in disastrous consequences for the millions of mental health and addiction patients.

Finally, the 9^th Circuit was advised that the first panel’s holding that, contrary to the UBH insurance plans’ plain terms, UBH can evaluate medical necessity using its finance department’s preferred standards rather than the medical community’s standards and that is morally, ethically and legally wrong. As dozens of organizations have told the 9^th Circuit, this conclusion is both wrong and an incalculable setback in the nation’s fight against the mental health and addiction crisis.

If the the three judge panel’s decision is allowed to stand, a blueprint will be established as to how insurance companies can get around the Mental Health Parity Act of 2008 by simply establishing their own internal guidelines and ignoring generally accepted standards of care. The dollars will continue to flow to insurance companies in tsunami like fashion, and lives will continue to be lost in riptide like fashion.

Instead of continuing to pontificate, the following demonstrates the crisis we are faced with today:

Not just the mere biological aspects of our presence on this planet. Instead, what defines our very existence on this, the third rock from the sun?

Through the miracle of that which we know as life, our physical self comes into existence. We grow, our bodies mature, evolve. And yet, ironically, each day we live brings us one day closer to our last day of existence.

We are certainly justified in asking ourselves, at the very core of our existence, who are we? What defines us? Do we have a soul? An eternal existence, something so incorporeal that it is beyond our current knowledge and comprehension. Who and what are we?

We do know that the human body is comprised of matter and energy. That energy is both electrical (impulses and signals) and chemical (reactions). At any given moment, roughly twenty (20) watts of energy are flowing through our bodies … enough energy to power a light bulb. Energy that cannot be destroyed.

The simplified version of the “First Law of Thermodynamics” states that energy can neither be created nor destroyed. It can however, be transferred.

As our physical shell erodes and then expires, our collection of atoms must be repurposed. Those atoms and that energy will always be in existence. Therefore, our “light,” that is, the essence of our energy — not to be confused with your actual consciousness — will continue to echo throughout eternity in some fashion.

So, what does that “repurposing” become? Does it take the form of the traditional, westernized views of heaven and hell? Reincarnation? Is our essence, our energy kept alive through the memories embraced by our loved ones? Is our essence absorbed into the greater cosmos? Or does one embrace the view of the Nihilist, that is believing in nothing at all, including the First Law of Thermodynamics?

Whatever a person’s belief, it is inextricably intertwined with our physical existence on this planet. Who we are. And as such, it absolutely must be addressed if our physical existence is going to be terminated with the assistance of the medical community.

Last year, Dr. Jennifer Gaudiani wrote on the topic of “Terminal Anorexia,” a term that she invented. And she acted upon it. When a person is complicit in assisting another human being in the taking of their own life, every possible related topic must be exhaustively addressed.

The physical.

The emotional.

The mental.

The illness.

And yes, the spiritual aspect.

There must be no doubt. There must be collaboration among medical doctors, mental health physicians, palliative care, hospice care and yes, spiritual advisors. Nothing must be overlooked. Because all are inextricably intertwined. Especially when dealing with matters involving the brain… and the soul.

The Brain – Spirituality Connection

Our brains are not built to measure the absolute value of anything. All that we perceive or feel is colored by expectation, comparison, and circumstance. There is no pure sensation, only inference based on sensation. In our minds, there is no such thing as objective value, even for something as fundamental as a limited number of years of life.

The brain spends much of its time and energy actively making predictions about the future—mostly the next few moments. Am I likely to become hungry soon? Is that approaching stranger a friend? These types of predictions are deeply rooted, automatic, and subconscious. They can’t be turned off through mere force of will.

Because our brains are organized to predict the near future, it presupposes that there will, in fact, be a near future. In this way, our brains are hardwired to prevent us from understanding the totality of death. We can’t truly imagine our own deaths. Our brains are built on the faulty premise that there will always be that next moment to predict. We cannot help but imagine that our own consciousness endures.

So, what happens when a medical professional advises us that our days are numbered? And our brain is forced to consider previously unthinkable probabilities.

Some studies indicate that embracing spirituality reduces the depression, anxiety and fear associated with death.

Most of the world’s major religions have explicit afterlife/reincarnation stories (Judaism is a notable exception). Islam, Sikhism, Christianity, Daoism, Hinduism, and arguably, even Buddhism. This organized religious thought generally takes the form of a bargain: Follow these rules in life, and you will be rewarded in the afterlife or with a favorable form of reincarnation or by melding with the divine.

The soul. Our brains. Our on-going consciousness. Our bodies. All inextricably intertwined. And before our physical existence is extinguished, all of these complexities must be thoroughly explored and questioned. Especially if we are complicit in the taking of another life.

I have read the articles on PAS or Medical Aid in Dying written by Dr. Gaudiani a number of times. I have listened to the podcasts in which Dr. Gaudiani discussed this topic. And universally, there is one important topic that is completely missing. That is … the issue of spirituality. The soul. The brain’s perceptions of our existence. What did Gaudiani’s three (3) patients believe? Did their belief system in even the smallest way, impact their views on PAS and what comes next? If spiritual leaders became involved, why is there no mention of them and their importance?

We all understand that spirituality for the most part, is not included as an important consideration in programs offered by most eating disorder centers, hospitals and professionals.  There are no “evidence-based” studies indicating the effectiveness of spirituality in eating disorder treatment programs. Perhaps this is due in part to the fact that spirituality, by its very essence, is not based upon demonstrable facts … but upon faith. Upon hope. Upon something that cannot be demonstrably measured.

However, sometimes hope and faith are the only things a family have to cling to as their loved one continues to fight. A belief in something so much greater than ourselves. Hope.

Hope was finally extinguished for those three (3) patients. Their souls are no longer on our plain of existence. Was everything humanly possible done to try to salvage hope? That certainly is not for me to decide. But perhaps the boards of medicine in various states who have been, and will continue to be contacted, will decide.

In the meantime, embrace the hope that exists within your head, your heart.

Let your soul sing.

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?

For the eating disorder community, January 2023 came in like a lion. It also left like a lion.

On December 11, 2022, “60 Minutes” aired a segment on the manner in which social media, particularly Instagram, exposes our children to harmful content. Content which includes body shaming, stigma and pro-anorexia content. Content which includes instructions on to commit suicide. Content revealing that the biggest social media platforms do not implement nor enforce age restrictions for access to controversial and harmful websites.

60 Minutes’ investigation further revealed that Facebook had actual knowledge that the Instagram’s app was being utilized to expose our children to this harmful and deadly content.  

It should come as no surprise that one entity, Meta Platforms, Inc. [an entity started by Mark Zuckerberg] owns Facebook, Instagram, WhatsApp and other social media platforms. 

This 60 Minute segment is embedded here: 

https://www.cbsnews.com/news/facebook-instagram-dangerous-content-60-minutes-2022-12-11/

To state that we should be alarmed would be charitable. In fact, we should be mortified. 

As you watch this segment, look closely at the father’s pain, a father whose beautiful daughter took her own life… only after she learned how to hang herself through information available on social media. 

Social media is not going away. But it can be investigated and the entities owning social media platforms can be made to answer for criminal conduct. The Meta companies owned by Zuckerberg are multi-billion dollar entities with influence and power. And we must surely find a way to effectively counter that influence and power. 

When these types of tragedies are brought to the attention of the general public, more often than not society gnashes its teeth, waives its angry fists at the sky, demands that changes be made until … society is distracted by the next “click bait” story which grabs the attention of the “Tik-Tok — Instant Gratification, Internet Generation.” 

As expected, society got distracted by the next click bait story.

AAP Guidelines

On January 9, 2023, the American Academy of Pediatrics issued its comprehensive, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity” (“AAP Guidelines”).

To say the AAP Guidelines are problematic again, would be charitable. The AAP Guidelines were co-written by 21 doctors, health researchers and “obesity experts.”

Amongst other questionable findings, the AAP Guidelines advise that health care providers may refer children as young as 2 years old to “intensive health behavior and lifestyle treatment” programs if they have a body mass index in the overweight or obese range. For children ages 12 and up with an obese BMI, doctors are encouraged to prescribe weight-loss medications and to offer adolescents aged 13 and older with “severe obesity,” a referral to a bariatric surgery center.

The authors insist that the AAP Guidelines are a brave leap forward in the fight against childhood obesity, which they frame as a “complex and often persistent disease” requiring early and aggressive treatment.

But then, the AAP Guidelines also acknowledge that experiences of “weight stigma, victimization, teasing and bullying” are major challenges faced by kids in larger bodies that contribute to disordered eating and worse mental health outcomes. They note that some health care providers are biased against fat patients in ways that compromise the quality of care and contribute to more severe illness and even death.

Well, duh! I am confident that we have a firm grasp of the painfully obvious. The AAP may wish to start to limit its platitudes to the merely obvious.

As a result, a number of eating disorder organizations and advocates issued harshly worded criticisms of the AAP Guidelines. As well they should have. But some obvious questions must also be asked.

The first question which has not being asked is …

Why are there no eating disorder experts listed as co-authors of these guidelines?

Did the AAP reach out to any eating disorder organizations? If so, did the AAP receive a response?

Why did the AAP issue these guidelines with complete ignorance of the horrible ramifications of eating disorders on our children and loved ones?

Besides issuing harshly worded criticism, who in the eating disorder community has the ability, knowledge, wisdom and contacts to meet with the leadership at AAP, to intelligently collaborate and devise a concrete plan to bring to the attention of AAP the justifiable concerns of the eating disorder community? And to have the AAP amend its guidelines to take into account the concerns of the community.

This type of action is incredibly important before another event occurs which will distract the “Tik Tok” generation of leaders to focus on the next drama.

And then, Oops … too late.

Ozempic has arrived.

What may you ask is Ozempic?

The FDA approved Ozempic for people with type 2 diabetes in 2017. But there is another developing off-label usage.

Ozempic is not approved for weight loss. But, doctors have begun to prescribe it off-label for that purpose. It is specifically directed for weight loss in adults with obesity or those who are overweight and have least one weight-related health condition, such as high blood pressure or cholesterol.

So, how does Ozempic work? Ozempic is a semaglutide designed to mimic a hormone that signals to the brain when a person is full and promotes the release of insulin, a hormone that stops blood sugar from getting too high. In turn, the medications can lower blood sugar levels and suppress appetites.

Prescriptions for Ozempic tripled from 2021 to 2022, according to data from the prescription drug discount company SingleCare, which has more than 5 million members. In fact, in August 2022, the FDA reported a shortage of Ozempic.

But complications raise great concerns. Medical experts said they consider Ozempic to be a lifelong medication. This is because like many drugs, the effects of semaglutide stop when patients stop taking it.  So some people regain weight.  

Novo Nordisk, the pharmaceutical company distributing Ozempic issued a statement to NBC News:

“This supports the belief that obesity is a chronic disease that requires long-term management, much like high blood pressure or high cholesterol, for which most patients remain on therapy long term,” the company added.

Ania Jastreboff, an associate professor of medicine at the Yale School of Medicine said, “Obesity is a neurometabolic disease. It is a chronic, treatable disease. We really need to treat obesity as we treat any other chronic disease, with effective and safe approaches that target underlying disease mechanisms.”

Coincidentally, Jastreboff serves on the scientific advisory board of Novo Nordisk, Ozempic’s manufacturer.

As for one of its side effects, (as if a life-long addiction to the drug was not enough), there is the issue of “Ozempic Face.” “Ozempic face is a bizarre side effect reported by Ozempic patients who claim the drug is making them look older. An overuse of the drug could result in a person losing weight too quickly. The buccal mucosa – the fat – leaves your face, and you become gaunt looking.

In addition to concerns over “Ozempic face” and the older appearance it allegedly causes, experts have warned that the drugs can cause other more serious side effects, including increased risk for rare forms of thyroid tumors, vision changes, kidney problems and gallbladder issues.

During the last week of January 2023, foxnews.com ran a story on Ozempic.

In the most recent episode of Bill Maher’s HBO show, “Real Time” he remarked, “There is this new drug Ozempic. It makes you lose weight. It works … but it makes your face fall off. It makes the face look very old.”

He then stated, “They are prescribing it for kids under 12.”

My God.

Social media is knowingly and intentionally directing our children to harmful sites in which they can learn about pro-anorexia and suicide.

The American Association of Pediatrics has issued guidelines which will increase eating disorders in our children.

Pharmaceutical companies are distributing a drug, and medical professionals are prescribing this drug to our children, which they must take for the remainder of their life in order for them to lose weight no matter its many side effects.

Meanwhile, our so-called leaders sit on the sidelines. Clutching their pearls. Chewing their fingernails. Playing checkers while the rest of the world plays 3-D chess. Back-stabbing anyone whose ideas or views differ from theirs.

And all the while, our families, our children pay the price for this incompetence. This neglect.

When is enough, truly enough? When will accountability be demanded? When will we become tired of the ever-worsening statistics in eating disorders? Statistics which are measured in the taking of human lives.

Our leaders’ failure, our community’s failure, is measured by that ever increasing number of lives being taken. And the community’s inaction. When is enough… enough?

Once more, Christmas is upon us. A time for family and friends. A time for laughter and love. A time for life. Memories (or the anticipation) of young children yelling and laughing as they run to the Christmas tree to see what Santa brought them. A child’s sweet, innocent laughter, those angelic faces reflecting boundless excitement fills our hearts with incredible joy.

And yet, for parents like me, parents who have had a child taken, it is also a time reminding us of our loved ones who are so missed. We grieve.

At this time of the year, we are so loath to let others see that grief within us After all, it is a universal time of joy. Conflicting feelings abound. One of our most fervent Christmas wishes is that others simply embrace more fully their families, their beloved children, their loved ones. And we search for words to convey that hope. Words that sometimes best come from others.

I wonder whether gifted authors understand that their words can resonate for generations? Do they understand that they are mere conduits for a message so much greater than themselves?  Do they understand that sometimes the written word touches us in a way that does not diminish over the years?

In 1993, Richard Paul Evans self-published a short book entitled, “The Christmas Box.” It was intended to be a story of love directed to his daughters.

The book centers around a young man, Richard, his wife and their young daughter, Jenna. Like so many young men, Richard places great emphasis on his career to the exclusion of his family, particularly Jenna.

In order to save money, Richard and his family move into a grand, Victorian home owned by an elderly woman, Mary. This arrangement includes the family caring for some of Mary’s needs. Then, Mary sees that Richard is trading diamonds for coal. And as such, she tries to inspire him to find that which is important.

While in the house, Richard finds a box, a Christmas box.  The Christmas box, originally intended to hold a Bible, has within it letters that Mary has written to a deceased loved one. Through the discovery of this box and the letters within, Richard discovers the true meaning of Christmas … the true meaning of love.

I cannot improve upon the author’s words. I can only quote his incredible message to us all:

“I sat down in the rocker in front of the illuminated Christmas tree and lay my head in my hands. Somewhere between the angel and Mary’s house I had figured it out. The first gift of Christmas. It just came. It came to my heart. The first gift of Christmas was love. A parent’s love. Pure as the first snows of Christmas. For God so loved His children that He sent His son, that we might someday return to Him.

“I understand what Mary had been trying to teach me. I stood up and walked up the stairs where my little girl lay sleeping. I picked up her warm little body and, cradling her tightly in my arms, brought her back down to the den. My tears fell on her hair. My little girl. My precious little girl. How foolish I’d been to let her childhood, her fleeting, precious childhood slip away. Forever. In my young mind everything was so permanent and lasting. My little girl would be my little girl forever. But time would prove me wrong. Someday she’d grow up. Someday she’d be gone and I would be left with the memory of giggles and secrets I might have known.

“Jenna took a deep breath and snuggled close for warmth. I held her little body tightly against mine. This was what it meant to be a father, to know that one day I would turn around and my little girl would be gone. To look upon the sleeping little girl and to die a little inside. For one precious, fleeting moment, to hold the child in my arms, and would that time stood still.

“But none of that mattered now. Not now. Not tonight. Tonight Jenna was mine and no one could take this Christmas Eve away from me but me. How wise Mary had been. Mary, who knew the pain of a father sending His son away on that first Christmas morn, knowing full well the path that lay ahead. Mary understood Christmas. The tears in the Bible showed that. Mary loved with the pure, sweet love of a mother, a love so deep that it becomes the allegory for all other love. She knew that in my quest for success in this world I had been trading diamonds for stones. She knew, and she loved me enough to help me see. Mary had given me the greatest gift of Christmas. My daughter’s childhood.”

The cold winds of anguish and grief are strong enough to put a frost on the heart of many people. But not me. I have a little warrior who helped so many before she was taken. A little warrior who, until my last day, will continue to inspire me. A little warrior who taught me the true meaning of love.

And so, during the Christmas Season, and for the rest of the year, embrace your beloved children. Laugh with them. Tell them you love them. As only a parent can. I love you Morgan. I love you Hanford (my beloved son). Each day, you teach me new lessons in how to be a better daddy, a better man.

And I certainly cherish that as my Christmas present.