Download From Ana and Mia With Love

Proceedings of The National Conference
On Undergraduate Research (NCUR) 2012
Weber State University, Ogden Utah
March 29 – 31, 2012
From Ana and Mia With Love: An Ethical Debate of Online
Pro-Anorexic/Bulimic Websites
Karleigh Ellsworth
Department of Philosophy
Utah Valley University
Orem, UT 84058 USA
Faculty Advisor: Dr. Jeffrey Bulger
Abstract
Online pro-anorexia/bulimia websites promote the idea that eating disorders are not diseases or illnesses, but rather
represent lifestyle choices. Anorexia and bulimia are endorsed as skills which are achieved through the assistance of
community forums, chat groups, and blogs. Public online communities create connections and bonds through
exchanged sympathetic support or advice to seeking individuals. “Pro-ana/mia” websites cause much ethical debate
in that the majority of the forums provide tips and tricks that substantiate dangerous behavior including weight loss
competitions, photo comparisons while rewarding those whose bones are most visible, techniques on purging
quietly, and learning to lie to family and friends about lifestyle choices. The purpose of this research is to discuss the
ethical and non-ethical effects of pro-ana/mia websites through a critical analysis of select websites using a proeating disorder perspective in order to demonstrate the principles of autonomy, beneficence, nonmaleficence, and
justice. Due to the fact that the moral principles found in Principlism have prima facie standing, the process of
distinguishing which principles obtain higher importance is fundamental.
Keywords: Pro-Anorexia/Bulimia, Ethics, Principlism
“Subdue your appetites, my dears, and you’ve conquered human nature.”
- Charles Dickens
1. Introduction
Despite the fact that eating disorders have the highest mortality rate of any psychiatric disease, countless individuals
turn to anorexia and bulimia in a glorified manner in which emaciated perfection is the goal. Pro-ana/mia websites
exist as advocates of the pro-ana/mia movement with an appealing purpose of action to support and assist
individuals to be successful in their lifestyle choices. Principlism guides an individual through a process of
determining whether or not moral ethics are present in pro-ana/mia websites.
1.1 Autonomy:
Autonomy is a basic moral principle derived from the Greek words autos meaning self and nomos meaning rule,
collectively resulting in self-rule. Autonomy constitutes independence and freedom to determine one’s own actions,
behavior, etc. Considered to be a basic human right, the principle guarantees that when an individual has a right,
others have a reciprocal obligation. Autonomy is composed of both positive and negative rights which state that
society has an obligation to provide something as well as an obligation to not interfere.
Pro-ana/mia websites are open to the public in which an individual may voluntarily enter at their own risk, or
safety. When considering autonomy as a positive right, pro-ana/mia communities do an excellent job at providing
genuine support for those who seek it as well as providing tips and tricks for those who desire to live anorexic and/or
bulimic lifestyles. If an individual were to type “pro-eating disorder websites”, “pro-ana/mia movement”, etc., the
search engine will find pages and pages of websites relating to the topic. Forums, chat groups, and blogs are
available to anyone who has access to the internet.
The majority of active members of the blogs and forums are female teens with many girls as young as eleven and
twelve. The age factor raises concerns as the issue of minors vs. adults comes into play. Do minors require
autonomy as a right? Is paternalistic behavior only justifiable in the best interest of the minor? If so, may the minor’s
best interest possibly be a pro-ana/mia lifestyle choice for higher self-esteem and a better self body-image?
Questions such as these arise often as the four principles of autonomy, beneficence, nonmaleficence, and justice
specify and balance each other in order to make a rational and reasonable decision.
By making the information so easily accessible for individuals to become involved in the online pro-ana/mia
community, the websites successfully oblige to an individual’s positive right to information but issues of
beneficence, nonmaleficence, and justice may at the same time be violated as will be further disclosed.
Autonomy as a negative right requires society to not interfere with an individual’s personal choice. Pro-ana/mia
websites may persuade and appeal, but their goal is not to force individuals into living an anorexic and/or bulimic
lifestyle. As a member of the online community, an individual may actively participate, browse out of curiosity, or
terminate their association whenever he/she pleases.
Pro-ana/mia websites make a further connection between anorexia and bulimia and the notion of free will. By
overcoming the impulse to eat, it may be reformed as an “exercise of volition” rather than the pre-established
reflexive impulse to eat. In “Pro-Eating Disorder Websites: Users’ Opinions”, a connection to the philosophical
viewpoint of Kant is discussed. Kant believed that in order to be free, human beings must surpass the “domain of
natural causation to which appetites belong.”1 Therefore, individuals who live a pro-ana/mia way of life are utilizing
free will which society, in fact, promotes.
1.2 Beneficence:
Beneficence is a basic moral principle which contributes to the welfare of others i.e., the maximization of benefits.
In short, beneficence means “to do good”. It can be argued that pro-ana/mia websites promote beneficence as they
offer support to individuals who may feel lonely and unaccepted by choosing the lifestyle most others reject, may be
depressed about their weight or body image, or may feel that family and friends do not understand their reasoning.2
Through reading segments of support group forums and blogs, it is evident that the online community successfully
contributes to the welfare of troubled individuals. The following two narratives of women’s struggles living with
anorexia and bulimia are emblematic of those found on pro-ana/mia websites:
(1) I am so glad to find someone/something that supports me, and my decision to be perfectly skinny.
Why’s everyone always trying to fight us?3 , 4
(2) I binged a little yesterday so this should be “fasting day one.” But today will be a better day. I’m now
90lbs (again). So I have to get down to 85. I need some support! i [sic] love you girls! Thinspo: (followed
by photographs of emaciated women).5
The promotion of beneficence is also manifested through the online community’s ability to provide information to
those seeking such. By possibly preventing suicide cases, pro-ana/mia websites offer not only refuge, but also tips in
order to lose weight resulting in positive self-esteem. By congratulating one another when starvation periods are
successful or admiring each other’s emaciated photographed bodies, it truly allows for a positive environment within
the community.
1.3 Nonmaleficence:
Nonmaleficence is a basic moral principle requiring the minimization of burdens by not harming others. In short,
nonmaleficence means “to do no harm”. In relation to pro-ana/mia websites, the principle of nonmaleficence may be
argued against the websites as being ethical. In order to determine whether nonmaleficence is promoted through the
websites, it is first necessary to define the term “harm”. According to Merriam-Webster Dictionary, harm is defined
as “physical or mental damage.”6 Damaging the physical or mental health of an individual through any method
results in a violation of nonmaleficence. Are the websites harming individuals? For those who believe anorexia and
bulimia are eating “disorders” which are defined as the disturbance of regular or normal functions,7 it can be argued
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that the members of the websites are indulging in mentally and physically dangerous behavior through a
deterioration of individuals’ bodies and minds. However, for those who rely on anorexia and bulimia as a way of life
will argue against the claim that the websites are harmful.8 In order to further develop the issue of nonmaleficence, it
is essential to understand the quantitative and qualitative benefits and burdens.
The principles of beneficence and nonmaleficence require the maximization of benefits and the minimization of
burdens. In many instances, these distinctions are conceptually difficult. One of the most interesting difficulties is
the distinction between quantitative and qualitative benefits and burdens. In “Moral Philosophy: A Theoretical and
Practical Approach To Moral Decision-Making”, Jeffrey Bulger explains that if no qualitative distinctions between
benefits and burdens existed, it would then be possible to apply a purely quantitative assessment. Bulger states:
Under this quantitative rubric a person could just draw, for example, two columns listing benefits of a
moral decision in the first column and burdens in the second column, sum up each column, and if the
benefits outweigh the burdens then the person ought to go with the decision, if not then the person ought
not to go with the decision. However, if one unit of measure differs qualitatively from another unit of
measure then the whole process becomes nonsense as the agent will be comparing apples with oranges.9
To the majority of individuals associated with an anorexic and bulimic lifestyle, pro-ana/mia websites undoubtedly
offer both benefits and burdens. By creating a list of benefits and burdens, or “pros” and “cons”, as Bulger described
in relation to the effects of pro-ana/mia websites, it is clear that a quantitative assessment interferes with justice to
either standpoint. For example, a benefit that may arise on the list is the ability to learn tricks about hiding what you
are or are not eating in the presence of family members. However, a list of burdens may quickly contradict the exact
benefit of secrecy to family members as a negative impact; a twelve-year-old girl may stand by the refrigerator
several times each day in order to relay to others a perceived notion of eating. She may be on the verge of death and
in desperate need of hospitalization. In regard to this specific case, the twelve-year-old girl’s goal is not to die, but to
be acutely thin. The initially-listed benefit of encouraged seclusion in order to achieve weight loss may now be
considered a burden to not only the individual who is starving herself, but a burden to the family by being
irresponsible without realization. The qualitative measure of weight loss and death differ in that even if a greater
number of benefits exist, death as a burden will outweigh the benefits.
According to “The Pros and Cons of Change in Individuals with Eating Disorders: A Broader Perspective”, a
study was implemented in order to measure the pros and cons of eating disorder symptoms among cases and the
advantages and disadvantages of endorsed eating disorder-themed groups. It was found that the perceived benefits of
an eating disorder for individuals with anorexia are having a sense of safety, structure, specialness, and the
communication of emotions while the perceived benefits for individuals with bulimia is the ability to eat and still
stay slim.10 The participants also perceived several negative aspects to their eating disorders such as guilt, low selfesteem, etc. However, all participants agreed enduring through their eating disorders was worth the benefits.
1.4 Justice:
Justice is a moral principle that can be defined as “the social protection of individual and social rights and liberties
and the implementation of the fair distribution of benefits and burdens.”11 One of the two criteria of evaluating
justice includes moral authority which consists of individual controlled morality vs. government controlled morality.
Libertarians exist at the extreme down position on the political compass of social morality. This point of view
maximizes personal moral autonomy and minimizes government authority. Having a very high respect of individual
autonomy, individuals are not forced into compliance or punished for noncompliance, but instead, utilize a process
of fair procedures. Authoritarians exist at the extreme up position on the political compass. In opposition with
Libertarians, this point of view maximizes governmental moral authority and minimizes the importance of personal
moral autonomy while having little respect for personal autonomy.
Pro-ana/mia websites disseminate a Libertarian point of view in that an individual’s autonomy is maximized
through personal morality. Worried health-care professionals or family members who disapprove of pro-ana/mia
websites as a professional therapy substitution oftentimes use an Authoritarian standpoint by requesting the websites
to be shut down in the interest of restricting current or future patients and loved ones from the lifestyle that the
websites consistently support. However, in most cases the websites are never shut down as it is difficult to
distinguish between pro-recovery support groups and pro-ana/mia groups. A Libertarian standpoint of individual
autonomy is exercised daily as millions of viewers and participants of the websites live the life desired. Therefore, it
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can be argued that justice successfully abides in pro-ana/mia websites through the continued freedom of social rights
and liberties.
John Rawls’ theory of justice states justice as fairness through two principles which are: (1) liberties and (2) social
and economic goods. The first principle contains a set of equal basic liberties “that are necessary for the individuals
they represent to develop as political persons or citizens.”12 Five categories of primary goods exist in Rawls’
framework. The fifth category resonates in relation to pro-ana/mia websites which states the social bases of selfrespect. Self-respect, according to Rawls, involves “a person’s sense of his own value, his secure conviction that his
conception of his good, his plan of life, is worth carrying out.”13 The emphasis is not only on an individual’s ability
to independently assess the many aspects of him/herself, but most importantly the value of his/her fundamental life
commitments. As previously stated, the social bases of self-respect is a primary good which Rawls believes to be
useful for “pursuing any specific conception of the good or life plan.”14
One method in which the two principles of justice cultivate self-respect is through the associations made up of
individuals with similar interests and goals. Rawls states, “The internal life of these associations...provides a secure
basis for the sense of worth of their members.”15 Members of pro-ana/mia websites harbor close relations through
similar struggles, opinions, etc. which undoubtedly result in a close-knit association creating a sense of worth to
each individual involved. It has been reported that along with obtaining a sense of safety and control, an additional
perceived benefit of anorexia and bulimia is that the condition helps individuals feel attractive and confident, and
that maintaining the lifestyle makes them happy.16 As a result of the typical effects of anorexia and bulimia, many
cases feel a sense of superiority and perfection causing a greater sense of self-worth. If it were not for the existence
of pro-ana/mia websites, it may be argued that countless individuals may miss this opportunity of self-worth and
therefore, a primary good.
2. Conclusion
The principles of autonomy, beneficence, nonmaleficence, and justice have provided further insight into the
underlying question of whether or not pro-ana/mia websites are ethical. According to the principle of autonomy, the
websites allow an individual’s self-rule to determine his/her decision based on the positive right to provide
information and support as well as the negative right to not interfere with the individual’s decision-making process.
However, precedence becomes an issue with autonomy of minors vs. adults. Pro-ana/mia websites foster
beneficence through the maximization of benefits such as support, friendship, tips to reach ones’ goals, etc.
Nonmaleficence may be regarded as a red flag when discussing pro-ana/mia websites in that the term “harm” is
relative to each individual. In order to better understand the conceptual difficulty between quantitative and
qualitative benefits and burdens, creating a list of pros and cons may assist in the determination of benefits vs.
burdens, though oftentimes miscalculation may occur by way of value differences. Lastly, justice as a fair
distribution of benefits and burdens along with the distinction between individual controlled morality vs.
government controlled morality provides a glimpse into the political framework relating to the websites. Rawls’ fifth
primary good involving self-respect endorses pro-ana/mia websites as just and fair in which an individual acquires a
sense of worth.
The prima facie standing of the moral principles creates an opportunity to distinguish which obtain higher
importance than others. Although the websites promote all four principles, it seems that autonomy and beneficence
in their entirety efficiently thrive through availability, support, and appeal. Seemingly, nonmaleficence may not be
considered the highest importance as even though harm may be argued to be present, most cases report an anorexic
and bulimic lifestyle is worth it. The implementation of Principlism has effectively concluded the fact that online
pro-anorexic/bulimic websites are indeed ethical.
3. Acknowledgements
The author wishes to express her appreciation to faculty advisor Dr. Jeffrey Bulger for his meaningful support and
guidance throughout this research.
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4. Cite References
1. Emese Csipke and Outi Horne, “Pro-Eating Disorder Websites: User's Opinions,” European Eating
Disorders Review 15, no. 3 (2007): 196-206. Academic Search Premier, 16 Nov 2011.
2. Helen Sharpe, et al., “Pro-Eating Disorder Websites: Facts, Fictions, and Fixes,” Journal of Public Mental Health
10, no. 1 (2011): 34-44. CINAHL Plus with Full Text, 18 Nov 2011.
3. Pro-Ana Anonymous US website, 2007. 20 Nov 2011.
4. Krista Whitehead, “‘Hunger Hurts But Starving Works’: A Case Study of Gendered Practices In the
Online Pro-Eating Disorder Community,” Canadian Journal of Sociology 35, no. 4 (2010): 595-626. Academic
Search Premier, 16 Nov 2011.
5. Pro-Ana Anonymous US website, 2006. 20 Nov 2011.
6. Merriam-Webster Collegiate Dictionary, http://www.merriam-webster.com/dictionary/harm
7. Merriam-Webster Collegiate Dictionary, http://www.merriam-webster.com/dictionary/disorders
8. Annika K. Martin, “‘Stick A Toothbrush Down Your Throat:’ An Analysis of the Potential Liability of
Pro-Eating Disorder Websites,” Texas Journal of Women & the Law14, no. 2 (2005): 151-78.
Academic Search Premier, 16 Nov 2011.
9. Jeffrey W. Bulger, Moral Philosophy: A Theoretical and Practical Approach To Moral
Decision-Making, 114.
10. Corinne Gale, et al., “The Pros and Cons of Change in Individuals with Eating Disorders: A Broader
Perspective,” International Journal of Eating Disorders 39, no. 5 (2006): 394-403. Academic Search Premier, 16
Nov 2011.
11. Jeffrey W. Bulger, Moral Philosophy: A Theoretical and Practical Approach To Moral
Decision-Making, 114.
12. Jeffrey W. Bulger, Moral Philosophy: A Theoretical and Practical Approach To Moral
Decision-Making, 147.
13. John Rawls, “A Theory of Justice,” Harvard University Press (1999): 386.
14. Andrew M. Courtwright, “Justice, Stigma, and the New Epidemiology of Health Disparities,” Bioethics
23, no. 2 (2009): 90-96. Academic Search Premier, 18 Nov 2011.
15. Andrew M. Courtwright, “Justice, Stigma, and the New Epidemiology of Health Disparities,” Bioethics
23, no. 2 (2009): 90-96. Academic Search Premier, 18 Nov 2011.
16. J. Tan, et al., “Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values,”
Philosophy, Psychiatry, and Psychology 13, no. 4 (2006): 267-282. PsycINFO, 20 Nov 2011.
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