Forced Care

[Meshavrischika]

At which point is it okay to force medical or psychiatric care on someone who does not want it (i.e. those that choose not to seek treatment for say... cancer or bipolar depression).

I personally question the idea that someone "being a danger to themselves" is reason enough. That would include eating big macs if you wanted to take it far enough. I believe being a danger to others is a GREAT reason to keep someone isolated, but not to force treatment outright (in the case of a mental patient or in the case of someone with a non-curable contagious disease or something)

 

[GrannieAnnie]

In Australia, from my experience, if a person with mental illness is in acute and immediate danger of hurting themselves or others, they can be "sectioned" and forced into protective mental custody for a period of time. As far as forcing a person to take medication to save their lives, I don't think anyone has the right to do that. I think if a person has a non-curable contagious disease, then there must be some law to have put into isolation, but I am not aware of such a law.

 

[jayem]

Having worked in health care--though not specifically psychiatry--I still know that it's hard to ensure that someone who is acutely suicidal won't decide to take his family, or other members of the public with him. It does happen. In virtually all states AFAIK, the laws re. involuntary committment have protections for the patient. Any suicidal or homicidal risk has to be imminent. (And this pertains to severe depression--a treatable disease. I'm not talking about suicide related to terminal illness.) The patient has to be evaluated usually within 24-48 hrs, and his continuing danger has to be certified for committment to be extended. And he's entitled to a prompt judicial hearing, with legal representation, if he disputes such certification.

But the OP is more about morality than legality. Like the poem says, no man is an island. Does killing oneself really affect only the suicide? Don't most people have family or others who would be diminished by their loss? Do you think a parent of young children, or a breadwinner can kill him/herself without imposing major hardships on survivors? Which may have to be mitigated by the social service system. I think suicide can burden society as a whole, so I think society can impose reasonable measures to prevent it. And especially because separating suicide and homicide is sometimes tough, limited involutary committment--with protections--is warranted.

(Untreated or inadequately treated depression BTW, is a major societal and economic burden, which accounts for a lot of lost productivity and social stress.)

 

[Meshavrischika]

but by that logic, even someone who does not have any immediate family imposes hardship on those around him, if for no other reason than the expense of the state to process his dead body in the morgue, pay the medical examiner and bury the guy.

every action has an equal and opposite reaction. that is life. grading that reaction is too subjective to substantially say "this is a hardship" and "this is not" and make rules about it.

 

[SpaceProg]

I've had some first-hand experience with the psychiatric methods.

First of all, the focus is preventing the patient from harm, or to prevent the patient from harming others. Usually during a crisis, the patient is held involuntarily for 24-72 hours. Maybe medicated, usually councelled. After that time, if the patient is still a danger to him/herself or others, actions are taken; depending on what the health care professional and/or the family/spouse/guardians of the patient see fit.
When the patient resumes a stable state of mind, then he/she is able to continue making decisions for him/herself.

I see no problem with the above as long as the main focus is to prevent harm, and choice is returned to the patient when he/she is in a more stable state of mind.

 

[Caitlin.ann]

If they're a serious threat to themselves or others, then by all means lock them up until they get the help they need.

 

[Crazy Liz]

With cancer, so long as the person is an adult, I've never seen care forced on a patient against their will. Options from aggressive care to hospice care are explained. Sometimes not all these options are available. For example, some expensive kinds of chemo may not be available to welfare patients.

With mental illness, it's harder because what the person wants when medicated and what they want when not medicated may be different.

 

[BattleAxe]

I am dealing with this issue right now. I have a client who is mentally ill and I have tried hard to find her help only to be left banging my head against the wall. Today a Vererans social worker told me I was "too emotionally attached" and since I was not going to take her home with me to just "put her out" and let "nature take its course". I was fit to be tired. I sought a second opinion and gave the full story- client won't take a bath, sleeps in her clothes, sleeps under the bed, refuses medication, is obsessed with going to Disney World and sleeping in a U-Haul (which she thinks she can rent for twenty dollars a day) etc...literally. Well my second source said it is a shame and especally because she is a vet but she agreed- Put her out.
I run a homeless shelter by the way and this girl has long out stayed her time. I spoke with her therapist who told me "client X is a VERY sick woman." and left it at that.
She is 40 and not able to live on her own but she thinks nothing is wrong and will not even consider assisted living. The suggestion will cause her to run. So tomorrow I have to go in and tell her she has got to leave the shelter. She has actually made herself at home and bought a TV and spent a lump sum $1500 on DVD's (seriously).
What do you do with a person like this??

 

[wanderingone]

I am dealing with this issue right now. I have a client who is mentally ill and I have tried hard to find her help only to be left banging my head against the wall. Today a Vererans social worker told me I was "too emotionally attached" and since I was not going to take her home with me to just "put her out" and let "nature take its course". I was fit to be tired. I sought a second opinion and gave the full story- client won't take a bath, sleeps in her clothes, sleeps under the bed, refuses medication, is obsessed with going to Disney World and sleeping in a U-Haul (which she thinks she can rent for twenty dollars a day) etc...literally. Well my second source said it is a shame and especally because she is a vet but she agreed- Put her out.
I run a homeless shelter by the way and this girl has long out stayed her time. I spoke with her therapist who told me "client X is a VERY sick woman." and left it at that.
She is 40 and not able to live on her own but she thinks nothing is wrong and will not even consider assisted living. The suggestion will cause her to run. So tomorrow I have to go in and tell her she has got to leave the shelter. She has actually made herself at home and bought a TV and spent a lump sum $1500 on DVD's (seriously).
What do you do with a person like this??

Why hasn't she been given a protectice services worker and a protective payee if she spends funds that would have been enough to secure an apartment on DVD's?

As much as it drives me crazy knowing about the hundreds of unstable individuals who are discharged from shelter regularly I also know that many will NEVER choose to maintain any shelter for themselves. If they seek medical care somewhat reasonably, eat somewhat reasonably, don't threaten to hurt themselves or others then there is really no cause to insist they be allowed to use services intended as a short term solution to emergency homelessness.