Ethical Dilemma Discussion: Eating Disorders

Select one of the short case summaries included with these instructions. Read through the situation presented considering the ethical principles we have discussed:
Autonomy
Beneficence
Nonmaleficence
Justice
Confidentiality
Role Fidelity
Veracity

Identify an ethical dilemma in the case you select and discuss it completely. Recall that an ethical dilemma is a situation where you need to choose a course of action that requires that you violate one or more of these principles in favor of another that you - based on your own values and reasonable logic - consider to be more important in the given situation.

CASE:
Martha Revere had not seen her friend Kelly Franklin for several years, though they had kept in touch across
country via telephone and email. Now, Martha was going to Los Angeles for a convention and couldn't wait to see
Kelly.

They made plans to meet for dinner at a trendy California restaurant whose specialty was a giant salad bar. The
first thing Martha noticed about Kelly was how thin she was. She reminded herself, however, that several years
had passed, and that people change.

During the meal she watched with some surprise as Kelly consumed a huge amount of food. Kelly must have gone
back to the salad bar ten times. Each time, she filled her plate high with food, finished it, and excused herself to go
to the rest room. Martha didn't think much about it. She jokingly mentioned how much Kelly ate, and then let the
subject drop.

On the way back to her hotel, however, Martha thought about the dinner more carefully. What had Kelly been
doing in the rest room? Could she have been throwing up her food? Isn't that bulimia?

Bulimia (bulimia nervosa) is a psychiatric illness and an eating disorder, present in some 2 million people, mostly
women. It involves binge eating and then purging the eaten food by vomiting, using laxatives, or through serious
fasting. The binging and purging are often followed by guilt and shame, and the sufferer often feels out of control,
understanding that the behavior is not normal. Bulimia is very dangerous to one's health, and is often
accompanied by major depression. It is estimated that 5 percent of women have suffered from this condition.
Martha didn't know what to do. Hadn't Kelly's husband and son noticed Kelly's unusual behavior?

Ethical Considerations
Does Martha have some responsibility to attempt to stop Kelly's self-destructive behavior. Of course, legally, we
know there is no duty to act, but what about ethically? What ethical principles should be discussed in reaching a
conclusion - beneficence, nonmaleficence, autonomy, confidentiality, veracity, others?

This might be a good case to explore the potential consequences of Martha's decision — what would the likely
outcomes be of confronting Kelly about her behavior? Saving a life? Destroying a friendship? Creating trouble in
the relationship to find out she was wrong?

Something to think about: Given their "keep in touch" relationship, is Martha's intervening really going to make a
difference in Kelly's behavior? Wouldn't Kelly, as a grown woman, likely already understand the risks of her
behavior? Is the very high potential that it will ruin the friendship outweigh the very low potential that it will
change the situation?