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.
posted by Maurice Bernstein, M.D. @ 9:29:00 PM
10 comments
10 Comments:
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.
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.
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”.
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
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
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
I hope they lose every single patient they have if they resort to such morally repugnant way of doing things.
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.
James, I wonder if your conclusion "If a court finds grounds for malpractice by a client who refused treatment, then I question the validity and the credibility of the court" is less simple and is actually more complex to make that conclusion. For example, if a hospital through its staff makes an erroneous diagnosis or offers an inappropriate treatment program, misguided information to present to the patient for "informed consent" and then which led to the patient refusing treatment, there might be a basis for supporting an argument toward malpractice liability.
What do you think about this reasonable possibility? ..Maurice.
My husband told the hospital that he was very sensitive to painkillers and had reactions such as prolonged memory loss, rapid/slow heartbeat, zombie like behavior, tiredness, etc. They did not make note of this note. He was having a heart attack but his pain was to a dull ache with nitro and 4 mg of morphine. He wanted no more painkillers than that. However, against his will and unknown to him, the Lifeline air team gave him 100mcg of fentanyl. This sent him into a nightmare. They said he was alert but he remembers nothing except feeling he was floating above watching things unfold. He was only able to respond when prompted. He was supposed to be evaluated at another hospital so we could decide how to proceed on treatment but that was not to be. They took around his freedom of choice. They said they gave him informed consent 30 minutes prior to the procedure but he was drugged out of his mind. He would never consent to such a procedure without talking it over with me. He can't even select his shirt without asking me which one to wear with what. I was there but they didn't tell me what was going on for almost 3 hours. They signed his consent one minute before they gave him the Versed and more Fentanyl that he would have never agreed to if he had been given true informed consent. They stripped him naked without asking or letting him take care of it and left him exposed for 30 minutes without any type of cover. He was horrified but was unable to speak his mind per the drugs. He is a prostate cancer survivor and has suffered the incontinence effects from that and the doctor commented that he smelled as he hadn't been able to change his pad bc of the STEMI. He experienced extreme trembling and shivering from either the exposure in a very cold room, the drugs, or both. His blood pressure dropped severely.
They took away his rights and humiliated him. Why and was it only him or is this how they treat every man? We thought he was going to have evaluation on how to proceed. However, what we didn't know was they had already decided and although it was his life and mine, what we thought did not matter and how they violated and mistreated also did not matter. I will never seek medical treatment and for him, he is careful and stressed and knows no matter how careful he is, they can still do harm bc they can drug you at will and do whatever they want.
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