Is it Ethical to Prescribe Court Ordered Meds?

[docB]

The state Supreme Court in Conn. has decided that a bipolar patient can be forcibly medicated so that he can be competent to stand trial.

Story here.

The question is if it is ethical to be the doctor prescribing the meds to the patient. It is widely held that it is unethical for a physician to assist with an execution. Is it similarly unethical for a physician to administer meds with the intent of getting a person well enough to go to prison?

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[Apollyon]

Is it any different from court-ordered electroconvulsive therapy? That is performed hands-on by psychiatrists.

 

[VA Hopeful Dr]

The state Supreme Court in Conn. has decided that a bipolar patient can be forcibly medicated so that he can be competent to stand trial.

Story here.

The question is if it is ethical to be the doctor prescribing the meds to the patient. It is widely held that it is unethical for a physician to assist with an execution. Is it similarly unethical for a physician to administer meds with the intent of getting a person well enough to go to prison?

I can't speak for every state, but in mine there is a special psych hospital where prisoners too insane to stand trial come for 60 day stints to try and get competent enough to head to trial. They are forcibly medicated there.

I can see why its a concerning practice, but I'm OK with it. Everyone is guaranteed a day in court, this practice is just helping them get there.

 

[deleted87716]

Is it similarly unethical for a physician to administer meds with the intent of getting a person well enough to go to prison?

How do you know they're going to prison? Maybe they're innocent. They are presumed such until proven guilty, at any rate. As VHD said, everyone is entitled to their day in court.

It's really no different than any other situation where a patient is incompetent, is it?

 

[docB]

My concern is that medicating someone for the stated purpose of making them compentent to stand trial seems to not be clearly and unequivocally in the patient's best interest.

For example we would say it's unethical to do a rectal or pelvic exam on a patient who is brought in by the police because they have drugs shoved up there but is refusing the exam. It would certainly be in their medical best interest to have that removed but it would likely land them in jail.

BTW I bring this up just for the sake of mental masturbation, the idea doesn't actually bother me. I just see it as a bit of an inconsistency that participating in a execution is clearly unethical while doing this which can also be construed as being against the patient's best interests is not.

 

[Apollyon]

Well, in 1979 the US Supreme Court held that it was in violation of a person's rights to surgically extract a bullet from a person's leg against their will (I don't know if it is was on the grounds of the 4th amendment against reasonable search and seizure, the 9th amendment about otherwise not enumerated powers, or something else). At the same time, when I was a med student, there was a patient that had been admitted for abdominal pain after serving as a drug mule, and had not passed the container full of contraband. A court order was issued for an ex lap to get it. Apparently, taking a bullet out of a bone, when in no distress, is unreasonable, but, if it's an item in a hollow viscous, it's not.

In other words, that's "jurisprudence", of which I hold little or nothing is prudential.

 

[cpants]

Well, in 1979 the US Supreme Court held that it was in violation of a person's rights to surgically extract a bullet from a person's leg against their will (I don't know if it is was on the grounds of the 4th amendment against reasonable search and seizure, the 9th amendment about otherwise not enumerated powers, or something else). At the same time, when I was a med student, there was a patient that had been admitted for abdominal pain after serving as a drug mule, and had not passed the container full of contraband. A court order was issued for an ex lap to get it. Apparently, taking a bullet out of a bone, when in no distress, is unreasonable, but, if it's an item in a hollow viscous, it's not.

In other words, that's "jurisprudence", of which I hold little or nothing is prudential.

Court order or not, it is unethical to do an ex-lap on someone who does not consent. That's messed up.

 

[docB]

Court order or not, it is unethical to do an ex-lap on someone who does not consent. That's messed up.

And that's why I brought this up. Since we would view it as unethical to treat (by surgery or medication) a competent patient who is refusing court ordered treatment is it ethical to forcibly treat a mentally ill patient with the intent of making the patient suitable for prosecution?

 

[Apollyon]

And that's why I brought this up. Since we would view it as unethical to treat (by surgery or medication) a competent patient who is refusing court ordered treatment is it ethical to forcibly treat a mentally ill patient with the intent of making the patient suitable for prosecution?

The mentally ill are not competent (to which you allude). That is different from a person who is competent, whose refusal is wholly informed and understood.

That is why I ask again if it is the same as court-ordered electroshock therapy treatments. That has been occurring for years and years and years.

If the incompetent is made competent, then they get their right to trial. If they are acquitted, then they're free. If they're acquitted by reason of mental defect, that can work against them. If they can't be made competent, then they ain't gettin' out of the nuthouse.

 

[dpmd]

The person is ill, and you have a way to make them better. They are not able to make an informed decision whether to go along with treatment because of their illness. The fact that they are going to stand trial is irrelevant. Would you withhold treatment for another type of condition just so the patient wouldn't have to stand trial.

Or is the issue that they are competent to make an informed refusal and the court is saying we don't care-you are doing it our way. In that case, the doctor still presumably thinks the medication is in the patient's best interests, and therefore simply prescribing it isn't unethical. (For example, I might prescribe morphine or vicodin for a patient who had surgery even though they say they don't want pain meds). Administering it against the pts informed refusal would be considered unethical though. (So when that same patient is in the hospital I don't ask the nurses to hold him down while I put it in their IV or shove it in their mouth).

 

[Pharmavixen]

The person is ill, and you have a way to make them better.

Yes, and you treat them. This is what I think as well. In the jail where I work, the psychiatric cells are just down the hall from my office. The violently psychotic are frequently housed there, and I will often spend an entire day listening to a person scream themselves hoarse and kick and punch his cell door because we cannot force treatment, even onto an incompetent person, because we are a jail and not a hospital. And I think it's just wrong. It's inhumane to leave somebody in that state.

If we did force treatment, vitamin H + Ativan or whatever, and the patient became competent to stand trial, it's true that we would be facilitating the criminal justice system. But we're also making a sick person better.

Besides which, if the person can't go to trial d/t incompetence, we're just prolonging their incarceration.

AND in the specific case of bipolar disorder, the more you don't treat them, the more intractable their illness.

 

[hurdlepup]

For example we would say it's unethical to do a rectal or pelvic exam on a patient who is brought in by the police because they have drugs shoved up there but is refusing the exam. It would certainly be in their medical best interest to have that removed but it would likely land them in jail.

If it makes it any better, the drugs are topologically outside their body...

 

[dragonfly99]

Yes, and you treat them. This is what I think as well. In the jail where I work, the psychiatric cells are just down the hall from my office. The violently psychotic are frequently housed there, and I will often spend an entire day listening to a person scream themselves hoarse and kick and punch his cell door because we cannot force treatment, even onto an incompetent person, because we are a jail and not a hospital. And I think it's just wrong. It's inhumane to leave somebody in that state.

If we did force treatment, vitamin H + Ativan or whatever, and the patient became competent to stand trial, it's true that we would be facilitating the criminal justice system. But we're also making a sick person better.

Besides which, if the person can't go to trial d/t incompetence, we're just prolonging their incarceration.

AND in the specific case of bipolar disorder, the more you don't treat them, the more intractable their illness.

Great answer
Maybe you can get a 2nd job as an ethics professor...LOL.