Anorexia nervosa (AN) can create a complex clinical dilemma when severe malnutrition and medical instability coexist with a patient’s refusal of treatment. The challenge is compounded by limitations in traditional approaches to assessing decision-making capacity, the ways AN can alter beliefs, values, and attitudes toward treatment, and uncertainty surrounding when involuntary treatment is ethically and legally appropriate. This lecture provides clinicians with a practical framework for navigating these situations by examining capacity, autonomy, beneficence, and pathways to involuntary treatment, while incorporating evidence on treatment outcomes and patient perspectives. Learners will leave with tools to more thoughtfully assess capacity, recognize when the effects of AN may influence treatment decisions, and approach involuntary treatment decisions in a clinically, ethically, and legally informed manner.