My treatment program is voluntary, and that goes for people who have a body mass index of 10. Nobody is forced to come to my treatment program. Nobody is forced to stay; people can exit any time.
The program has in it elements that we think are evidence-based and supported by the scientific literature, so we believe we're practising in an evidence-based way. We also innovate in our treatment. We're one of the world leaders in developing better and newer treatments for anorexia nervosa, but it's voluntary. For most of what you would call the treatment programs in Canada, the treatment is voluntary.
Then on the other hand, there are people who are going to die right now, who are unwilling to come to treatment, and a decision is then made about whether to salvage them or not.
I'll give you two examples. We have a woman who is 23, who happens to be a medical student, who was going to die right away. She was on death's door in the emergency department, had been offered treatment repeatedly for months, would not consent to come to treatment, and a decision was made to partially weight restore her against her will to save her life for the moment. Another patient, 53, with 35 years' duration of illness, was in another local hospital in Toronto. I believe the decision there was made to let nature take its course.
The only circumstances under which people are treated against their will at this point for adults are where the person is going to die right away unless a medical intervention is made and a decision is made that the patient is too young and has not been sick long enough to simply let them die, but otherwise, the treatment is voluntary. It doesn't mean the patients like all of it. There are lots of anorexic patients in Toronto who will tell you that I am the devil on earth because of how my treatment program is structured, but it is voluntary.
There are limited choices for patients, very limited choices.
I think you're out of time and I've got to stop, but there are very limited choices and that's the big problem.