The Instigator
Republican95
Pro (for)
Losing
0 Points
The Contender
Kleptin
Con (against)
Winning
19 Points

Force Feeding of Anorexics

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Post Voting Period
The voting period for this debate has ended.
after 3 votes the winner is...
Kleptin
Voting Style: Open Point System: 7 Point
Started: 12/17/2009 Category: Society
Updated: 4 years ago Status: Post Voting Period
Viewed: 9,046 times Debate No: 10498
Debate Rounds (3)
Comments (7)
Votes (3)

 

Republican95

Pro

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Resoultion
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The resolution is as follows: Those who suffer from anorexia, when deemed by a medical professional that they are at a severe risk of death beacause of their low body weights, should be force-fed via a tube inserted through their nose, down the esphougus, and into the stomach for their own safety.

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Definintions
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Anorexia- is an eating disorder characterized by extremely low body weight, distorted body image and an obsessive fear of gaining weight. In most industrialized western countries, it is considered a mental illness.

Medical Professional-anybody who has obtained a degree, and is currently working, in the field of medicine. For the purposes of this debate, a medical professional would be a nutritionist.

A severe risk of death-a state in which somebody has a more than 50% chance of death within the next 7 days if immeadiate medical action is not taken.

Safety-the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be considered non-desirable. For this purpose of this debate, the physical safety of the anorexic is being taken into account.

Note: These definitions should be treated as rules, not contentions. If you have a problem with the definitions do not take the debate. I am not interested in semantics, I am interested in the issue at hand.

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Arguments
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1) Anorexia, since it is a mental illness, imparis the judgement of those affected. As so, Anorexics are not capable of making their own decisions when the consequences of their decisions could pose a severe risk to their safety. Therefore, capable medical professionals have to be put in the posistion of making their patient's decisions (beacause the patient is mentally ill); espicially if those decisions could result in the death of a human being.

2) Every medical professional have the obligation to preserve human life, no matter the circumstance. In the case of mentally ill patients, this espicially holds ture.

3) To allow an anorexic to not eat would be to make treatment of the disease impossible. It's kind of hard to treat a dead patient. The focus of medicine should be treatment. Prolonging the life of the anorexic will make treatment possible in the futre, therefore, there is an obligation to keep them alive.

I thank whoever accepts this debate.
Kleptin

Con

I thank my opponent for starting this debate.

My opponent's plan to force-feed anorexics to preserve their lives is noble, but not very well thought out. My opponent has stated that in his situation, the patient has a 50-50 chance of dying within seven days, in which case his treatment would be completely ineffective.

In the state that my opponent describes, the patient would have been malnourished for far too long to be able to use his or her gastrointestinal system. Moreover, the patient likely has little to no muscle mass and poor organ function. The patient would have to be given oxygen because the advanced state of undernourishment would have had severe effects on the diaphragm and the patient would be in great risk of respiratory distress. Since the oxygen would have to be provided in that manner, there would be no way to use an NG tube anyway physically.

Thus, even if the patient's GI tract were still functioning, it would not be feasible to perform this procedure. If my opponent goes through with this, he will likely cause gastric sepsis and intense pain for the patient, and he will lose his right to practice (if he were a doctor).

In fact, the common solution in this case is TPN, parental nutrition delivered intravenously. Several studies and published articles propose TPN in cases of what is called "Anorexic refeeding". NG refeeding is a common technique but has many GI complications even for mildly anorexic people, and brings up a wide variety of legal and ethical issues. TPN bypasses all of these issues as it is not force-feeding, but definitive medical treatment.

Total parenteral nutrition bypasses the GI tract and is compounded by pharmacists to include electrolytes, water, glucose, amino acids, and essential fatty acids. There is no digestion taking place with TPN.

Proper course of treatment for this patient would be to keep him or her on TPN until stabilized, treat liver or kidney failure if necessary or possible. If the patient ever regains his health and GI function, then a prescription should be written for an SSRI indicated for the treatment of anorexia nervosa. The patient should also be given dronabinol to induce appetite and begin therapy.

This method is far superior to what my opponent has proposed and is also supported by the medical community over NG tube feeding.

I look forward to my opponent's response. Thank you.

Sources:

The study
1. http://www.ncbi.nlm.nih.gov...
2. http://www.bentham.org...

Definition of parenteral nutrition from wikipedia
3. http://en.wikipedia.org...

4. My class notes and professional opinion.
Debate Round No. 1
Republican95

Pro

I thank Kleptin for accepting this debate. However, I would agree with him by saying that it will now be very boring. Despite, its boringness it will educational to all who read.

I will start by defending my argument.

My Opponent: "In the state that my opponent describes, the patient would have been malnourished for far too long to be able to use his or her gastrointestinal system."

I think that a source is in order here. Unless my opponent can upload a copy of his Master's Degree in nutrition, I do not think that he is qualified to make such claims without backing them up.

My Opponent: "The patient would have to be given oxygen because the advanced state of undernourishment would have had severe effects on the diaphragm and the patient would be in great risk of respiratory distress."

Another source please.

My Opponent: "Thus, even if the patient's GI tract were still functioning, it would not be feasible to perform this procedure. If my opponent goes through with this, he will likely cause gastric sepsis and intense pain for the patient, and he will lose his right to practice (if he were a doctor)."

Operatintg under this assumption, surgery should be illegalized. Surgery can cause extreme pain to the patient after it has happened; however, surgeries still happen. Surgeries still happen because the possible good benefits associated with it outweigh the possible negative affects that will accompany it. I would take stomach cramps over death anyday and I'm sure my opponent would too. Feeding the patient would have good benefits that outweigh the bad, therefore it is justifiable and the pain experience by the patient is not unessecary. The pain could be controled by medications.

I have now asked politley for my opponent to back up the claims that he as made. Since the rest of his previous argument is nothing more than countless details that rely on the assumptions he made above, I will attack his reasoning other than his arguments.

My opponent doesn't seem to understand medical ethics. A doctor is obligated to do whatever he or she sees as being in the best interests of their patient. If a doctor feels that feeding the patient is actually worse for their health than not feeding them at all, then he doesn't have to feed them. He isn't obligated to. Period.

Than you for your time.
Kleptin

Con

I regret to inform the audience that my post will be rushed in the interests of time. The bus I took back from my trip out of state was involved in an accident which dug into my schedule for several hours more than I expected. I will keep this short and sweet.

My opponent's main response in his last post was essentially that I can't prove my claims. My main points of contention is that my opponent's proposed mechanism of treatment will cause more harm to the patient than mine.

The main point we must drive home before we continue is that the patient is about to die. This is not an issue of headache and an upset stomach from missing a few meals. Even sailors marooned on an island for a week have a more excellent chance of survival compared to the patient my opponent is using. In order for the patient to have a 50% chance of death without immediate medical intervention, the patient WILL have the characteristics I state out of pure logic. I will still provide sources, however.

First, my opponent claims that I have no source justifying my notion that the patient has gastric complications forbidding NG tube refeeding. In the very source that my opponent decided to ignore, it showed that 80% of anorexics experienced prolonged gastric clearance times, which severely hinders the rate of survival. This is the data supplied, but it is up to a medical professional to explain to laypersons. Gastric clearance time increase equates to less nutrition absorbed by the body within the hospitalized time. For every meal, the patient gets less nutrition through NG feeding than by TPN. The source also states that postprandial gastric fullness leading to vomiting is a common occurrence, due to the fact that the stomach is not used to the presence of food and responds by ejecting it. This is also not seen in TPN. In some severe cases of prolonged anorexia, gastric rupture due to this distension is also possible. Severe constipation and intestinal compaction also result from NG feeding of anorexics in the mentioned state of severe malnutrition.

Now, for some new sources.
http://www.ncbi.nlm.nih.gov...

This source provides additional information regarding my position on GI effects of severe anorexia, as well as leading into the second issue.

http://www.ncbi.nlm.nih.gov...
http://www.diagnose-me.com...
http://www.ehow.com...

These sources show the correlation between atrophic gastritis and severe malnutrition, in which the stomach eats away its own lining after prolonged starvation, making it more difficult for the body to produce hydrochloric acid needed to break down food. Another reason why TPN is superior to NG refeeding.

Furthermore, dozens of articles will associate severe, prolonged malnutrition due to anorexia with electrolyte and mineral imbalance, both of which is very easily remedied by TPN and rather difficult to remedy by NG feeding. Those same articles will mention muscle wasting, which is true to the diaphragm as the diaphragm is itself, a muscle that will deteriorate with starvation.

My opponent makes some straw man arguments I will address:

My opponent is the one who does not understand medical ethics. The #1 rule of Hippocrates is to DO NO HARM. While my opponent's intentions are good, they will not provide the best care for the patients. I am not saying that we should not treat, I am saying that we should treat in the best way possible. I have nearly four years of medical education under my belt and understand the difference between casual wikipedia browsing and using academic knowledge in the clinical setting.

My opponent did not attack my reasoning, he committed a logical fallacy and attacked a straw man. He has contributed nothing to the discussion and has only asked for more information without reviewing my sources.

I have provided a vast amount of information showing that TPN is the superior treatment form over NG feeding while my opponent has not supported his treatment method at all. I hope he shall do so next round. Thank you.
Debate Round No. 2
Republican95

Pro

Republican95 forfeited this round.
Kleptin

Con

Regretfully, my opponent has forfeited his last round. I will now sum up the debate.

My opponent started this debate advocating the use of NG refeeding for anorexics. NG refeeding is the technique of pumping food into a tube through a patient's nose, into the patient's stomach, bypassing the act of chewing and swallowing. My opponent provided some arguments involving the fact that anorexics at a state of near death require intervention and also count as individuals without the proper mental capacity to exercise their right to decide on medical treatment.

In response, I have stated that if the patient is near death, NG refeeding is not the best technique. While NG refeeding is used, it is not used for patient with severe malnutrition as there are many gastrointestinal complications in those individuals. Furthermore, there are practical reasons relating to electrolyte, mineral, and vitamin imbalance present in these individuals which would make NG refeeding inferior to my proposed mechanism.

My proposed mechanism of treatment is TPN, or total parenteral nutrition, in which nutrients are given to the patient intravenously, bypassing the digestive tract in totality. This not only solves the issues of electrolyte, mineral, and vitamin imbalance, but also provides all the benefits of NG refeeding and also bypasses the controversy of force-feeding as it is recognized 100% as a medical treatment and not as force-feeding at all.

TPN is also safer and more efficacious for patients with severe malnutrition, and will lead to faster recovery times and fewer side effects.

All of these statements are based on data and research provided in my many sources above.

For that reason, I urge a CON vote. Thank you to my opponent and to the audience.
Debate Round No. 3
7 comments have been posted on this debate. Showing 1 through 7 records.
Posted by Chrysippus 4 years ago
Chrysippus
C: Con. If you must forfeit, let us know why. It is always a disappointment when you put effort and time into a debate, and your opponent doesn't even show up.

SP/G: Tied. Nothing to complain of. :)

A: Con. Always great to read a debate where one member has studied the issue, even if they tend to be slightly one-sided.

S: Con, easily. Both quality, and having bothered to do the research.
Posted by studentathletechristian8 4 years ago
studentathletechristian8
RFD:

B/A: Con / Con
Conduct: Con. I felt Pro to be a little on the rude side at some points during the discussion. Plus, Pro forfeited a vital third round.
S/G: Tied. Both sides were easy to read and knew how to seperate paragraphs.
C A: Con. Not only did Pro forfeit argumentation in the third round, but Con refuted all of Pro's arguments.
Sources: Con. Con provided various sources, while Pro did not.
Posted by Kleptin 4 years ago
Kleptin
I apologize for the delay, I was involved in a traffic accident. And had but minutes to post my argument after being out of state for several days. I would also like to remind my opponent that since it is his last round, he should cover all the things he did not respond to in my first round and should prepare to argue why NG feeding is superior to TPN feeding, and not simply attack my arguments. I consider this a fair warning because as Con, I end the debate and if my opponent did as he did last round, it will make this debate rather unproductive. Much thanks!
Posted by Kleptin 4 years ago
Kleptin
Away on a trip, will be back a few hours before this is due. Sorry for the delay.
Posted by Kleptin 4 years ago
Kleptin
Sorry to burst your bubble, but I just made it very boring XD
Posted by Maikuru 4 years ago
Maikuru
I haven't read the arguments yet but the resolution is very interesting.
Posted by wjmelements 4 years ago
wjmelements
Very tempting.
3 votes have been placed for this debate. Showing 1 through 3 records.
Vote Placed by Chrysippus 4 years ago
Chrysippus
Republican95KleptinTied
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Vote Placed by Koopin 4 years ago
Koopin
Republican95KleptinTied
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Vote Placed by studentathletechristian8 4 years ago
studentathletechristian8
Republican95KleptinTied
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Total points awarded:06