Toward dignity-centred ethics in the treatment of longstanding and severe eating disorders: a lived experience-led narrative review

Longstanding and severe eating disorders (LSEDs) are frequently marked by medical risk, therapeutic impasse, and exclusion from standard care pathways. Yet insufficient attention has been paid to the ethical dimensions of treatment for those with complex and longstanding illness trajectories, in particular from the perspective of those with lived experience. This paper aims to address this gap as a lived-experience-authored narrative review focused on the concept of dignity as a guiding value of ethical care in LSEDs. Informed by critical interpretive synthesis, narrative ethics, and reflective practice methods, the authors integrate multiple sources of evidence. They adopt a lens of epistemic injustice, situating subjective knowledge alongside empirical research findings and the wider conceptual and ethical considerations of treatment provision. The findings identify recurring patterns of undignified care in the treatment of LSEDs, including the normalisation of neglect, coercive practices, and exclusionary models of treatment. Principles and practical steps are outlined to inform dignity-affirming care, which include prioritising relational safety, co-produced decision-making, and re-medicalisation of LSEDs in ways that do not sacrifice autonomy. Ultimately, the authors determine that a dignity-centred approach to LSEDs requires a fundamental shift in how we understand risk, chronicity, and the place of lived experience in clinical ethics. This paper offers a conceptual and methodological framework to support that shift, calling for collective responsibility and structurally embedded forms of care that respect the knowledge, rights, and needs of those most affected by LSEDs.