The distorted body image and unrealistic perceptions that give rise to denial in anorexia pose an interesting ethical issue: how does this distortion and denial affect the patient's capacity to make treatment decisions? It could be argued that Pam's refusal to acknowledge her disorder represents a lack of the insight and comprehension required to make decisions about treatment. This, in turn, could call into question her de-cisional capacity and provide justification for involuntary commitment. The clinicians in Pam's case seem to be making this claim. But their other actions-such as obtaining Pam's consent to remove her gallbladder-seem to imply the opposite.
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