Bioethics Discussion Blog: Coerced Medical Care: Is That Ethical?

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Wednesday, June 20, 2012

Coerced Medical Care: Is That Ethical?

Coerced medical care means that the patient will or is having or has received medical care not by their own autonomous decision but because the legal system has decided, after consultation with the patient's doctors that such care must occur.  Dr. Julie Cantor discusses the matter in a New England Journal of Medicine free full text article in the June14 2012  issue.
The first paragraph sets an example:

Samantha Burton was 25 weeks pregnant when her membranes ruptured. Burton's obstetrician admitted her to Tallahassee Memorial Hospital (TMH) and prescribed continuous inpatient bed rest. But with two young children and a job to consider, Burton found the prospect of a 3-month hospital stay overwhelming. She decided to go home. When she tried to leave, authorities barred her exit.

Go and read the Journal article and then return with you own views regarding such legislative, medical or legal actions taken upon patients.
Under what circumstance do you find that a law or court decision should override any voluntary medical decision by the patient? Is it ethical to deny a competent patient's informed and autonomous decision?  Is there a difference if the issue is regarding a communicable disease versus a pregnancy? ..Maurice.


8 Comments:

At Thursday, June 21, 2012 9:12:00 AM, Blogger Hexanchus said...

Dr. B,

I agree with the author's conclusion that the patient's absolute right to refuse any treatment or procedure must be respected, and that physicians and hospitals should not be able to use the court system to override those decisions.

That said, I also agree with her statement that the patient's refusal should be an automatic prima facie defense against any specifically related negligence or malpractice complaint, and further that it should be automatic grounds for immediate dismissal of any such complaint with prejudice.

As I have stated many times, a patient has the absolute right to make any and all decisions with respect to their health care, but with that right comes the full responsibility for any consequences of those decisions.

The situation the article is based on is very different from that involving a communicable disease. While the patient still has the right to refuse treatment, society must also have the right to protect the general population from serious health threats.

For example, in the case of an individual that has a highly contagious disease that represents a serious threat to life, the patient still has the right to refuse treatment, but society also needs to have tools such as quarantine available to protect the general public from that disease. That said, any measures taken must be proportional to the seriousness of the threat and also the least restrictive necessary to accomplish the goal.

 
At Thursday, June 21, 2012 3:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Hexanchus, if the assumed risk of injury or death is just to one individual and not a community should the life of that one be important enough to warrant a coerced restraining of liberty or an invasive procedure on another? Should it make any difference if the individual at risk was already born or was still in the womb? This entire issue seems to revolve around a general question as to whether to be a "Good Samaritan" (bearing some personal burden but to aid another) should be subject to legal coercion. Any thoughts on that? ..Maurice.

 
At Thursday, June 21, 2012 7:53:00 PM, Blogger Hexanchus said...

Dr. B,
"...should the life of that one be important enough to warrant a coerced restraining of liberty or an invasive procedure on another?"

IMHO, absolutely not. In the case Dr.Cantor referred to regarding the attempt to force bone marrow donation, the court held “For our law to compel defendant to submit to an intrusion of his body would change every concept and principle upon which our society is founded. To do so would defeat the sanctity of the individual” and “raise the spectre of the swastika and the Inquisition, reminiscent of the horrors this portends” (McFall v. Shimp).

With respect to a pregnant woman, I agree with her position that for some inexplicable reason, some pregnant women have been forced to undergo treatment or procedures against their will and without the benefit of due process of law. IMHO, this is wrong.

Exactly when a fetus legally becomes a "person" is still gray area that has never been unequivocally legally established. Is it viability without medical life support? Is it live birth? Until it is, this is going to be an ongoing argument.

Another issue is if the conduct of the mother is legal. I.E. smoking, drinking and refusing medical care are all legal for an adult female. Preventing or interfering with the rights of a person to engage in an activity or make their own legal decisions should not happen without full due process, legal representation for the female and complete consideration of all positions. Illegal activity such as drug use, may be somewhat different depending of state law. Personally, I side with Illinois' position “the State may not override a pregnant woman's competent decision, including refusal of recommended invasive medical procedures, to potentially save the life of the viable fetus”.

 
At Thursday, June 21, 2012 10:23:00 PM, Blogger Doug Capra said...

In reference to this discussion, I think the writer/physician, William Carlos Williams, short story, "The Use of Force," is most interesting. Although it involves a child as patient, it still is relevant to this topic.
I'd also recommend other short stories by Williams that reflect his experience as a doctor visiting the poor urban slums.
You'll find the short story, "The Use of Force," at this link:
http://www.classicshorts.com/stories/force.html
Here's an interesting essay that asks whether this story is an example of child abuse:
http://suite101.com/article/exploitation-intimidation-and-abuse-in-the-use-of-force-a383095

 
At Saturday, June 23, 2012 11:31:00 AM, Anonymous Anonymous said...

A 22 yo man was taken by the police to a hospital and forced to give a urine sample. They didn't just wait for him to urinate, instead the cops held him down while a female nurse catheterized him to get the urine.

http://www.freedominourtime.blogspot.com/2012/06/judicially-authorized-rape-newest.html

 
At Sunday, June 24, 2012 1:44:00 PM, Anonymous Anonymous said...

Patients who are mentally competent must have the right to make their own medical decisions as long as they understand the consequences.

On the other hand, things should work both ways. I just read an article in Time magazine from a few months ago that most doctors lie to their patients because a. they think the patients cannot make their own decisions, or b. because the patient is very ill and they want to give that patient misguided hope. What happened to the truth? What happened to an equal equitable relationship where the physician works WITH the patient to develop protocols that work for both of them. That's the only kind of doctor I would select.

Taking patients rights away will only cause more avoidance of healthcare at whatever costs. This is the height of disrespect and taking the unbalanced relationship between doctors and patients to the breaking point.

Regarding pregnancy--women will eat, drink, gain weight, use drugs, smoke and do anything else they want when they are pregnant if they have a wanton disregard for their baby. They can even have an abortion if that is their decision.

Restricting competent patients is a slippery slope. Should the laws change to make this a viable option for hospitals, soon, they will have no patients.

There is no wiggle room for this one--cut and dry.
belinda

 
At Saturday, June 30, 2012 11:53:00 AM, Anonymous Anonymous said...

I hope they lose every single patient they have if they resort to such morally repugnant way of doing things.

 
At Saturday, June 30, 2012 3:26:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, the actions by the pregnant woman which might be classified as "wanton disregards" can be argued that they are disregarding unproven alleged hazards to their pregnancy and fetus. Hilde Lindemann writing an article "The Woman Question in Medicine: An Update" in the May-June 2012 issue of the "Hastings Center Report" cites the following unproven hazards that women were told were hazards and should be avoided to maintain a healthy pregnant body and a healthy fetus:
"quit drinking coffee, avoid an array of foods from cheese to sushi, to sleep in a specified position (currently, avoiding stomach and back with left side preferred to the right), to avoid paint (including those with low volatile compounds), to avoid changing the cat litter, not to sit in the bathtub more than 6 minutes,not to sample cookie dough,to avoid loud music and even to keep a laptop computer several inches from her pregnant belly 'just in case'". Lindemann states that there is no evidence that moderate consumption of alcohol is harmful to the fetus.

Therefore perhaps pregnant women disregarding these master social and unproven narratives as offered by books, friends and even doctors may not be as "wanton" but represent a need for the woman to attend to herself beyond attending to the valid issues of her pregnancy. ..Maurice.

 

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