Can anyone here clarify these ethics points?

[Knicks]

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According to Kaplan, a feeding tube is a treatment option that a [competent] patient can choose to have withdrawn, even if the feeding tube is for life-saving nutrition and life-saving hydration.

Isn't that suicide? and if so, shouldn't physicians prevent that from happening?


And while I'm on the topic of 'competence', according to Kaplan, mentally-ill patients have the right to refuse treatment.

How/why? Just look at how they are categorized: Mentally-ill. How do we know that their decision of treatment refusal isn't stemming from their mental illness? (notice the two separate underlinings).

Thanks in advance.

 

[McGillGrad]

Feeding tube, by law, is not medical treatment so you (or legal guardian) can refuse it.

Competence can only be determined by a judge. Unless unconscious, attempting suicide or inebriated (including under drug-induced delirium), the person is assumed to be competent. Mentally handicapped people are legally INcompetent. Mental ******ation is determined by a mental health professional.

"Mentally ill" is not the same as "mentally handicapped."

 

[Knicks]

Feeding tube, by law, is not medical treatment so you (or legal guardian) can refuse it.

So, you're saying Kaplan is wrong here.. no doubt.

Competence can only be determined by a judge. Unless unconscious, attempting suicide or inebriated (including under drug-induced delirium), the person is assumed to be competent. Mentally handicapped people are legally INcompetent. Mental ******ation is determined by a mental health professional.

"Mentally ill" is not the same as "mentally handicapped."

Of course they're not the same.

But if we have an institutionalized schizophrenic patient who refuses treatment, how are we to know whether "the voices in his head" are telling him to refuse the treatment as opposed to himself refusing?

 

[McGillGrad]

Kaplan says the same thing as I do. You may have misunderstood.

Once someone is involuntarily institutionalized, they are legally incompetent. Because in order to be involuntarily institutionalized, they must be ruled thus by a judge.

So, you're saying Kaplan is wrong here.. no doubt.


Of course they're not the same.

But if we have an institutionalized schizophrenic patient who refuses treatment, how are we to know whether "the voices in his head" are telling him to refuse the treatment as opposed to himself refusing?

 

[Knicks]

Kaplan says the same thing as I do. You may have misunderstood.

No, no misunderstood. You may have misread the OP.

I'll be more specific to help you understand:

Rule #6 on page 204 of the 2006-2007 Kaplan Behavioral Sciences Lecture Notes states, "Rule #6: Feeding tube is a medical treatment and can be withdrawn at the patient's request."

Focus on the bolded text.

That's not the same as:

Feeding tube, by law, is not medical treatment so you (or legal guardian) can refuse it.

Once someone is involuntarily institutionalized, they are legally incompetent. Because in order to be involuntarily institutionalized, they must be ruled thus by a judge.

ok fine, said patient is not institutionalized then.... the question still stands:

......how are we to know whether "the voices in his head" are telling him to refuse the treatment as opposed to himself refusing?

 

[McGillGrad]

I understand that you don't know much about ethics so I'll do my best to try to explain.

Because the feeding tube is only a life-prolonging procedure (not a life-saving medical treatment), it can be refused. The only case where you can force life-saving treatments is with people who have attempted suicide and minors.

I am embarrassed to actually define suicide to a grown man in medical school, but here goes...

...suicide is the willful act of taking your life...

Refusing a feeding tube may lead to death, but it is not willfully ending your life....LEGALLY

You can interject your silly opinion into this, but your opinion does not matter on the USMLE or in a court of law. Deal with it.

As for the non-institutionalized patient, THEY ARE COMPETENT AND CAN REFUSE TREATMENT.

Once again, this is the law and this is the way it is. What you think means diddly squat.

 

[Knicks]

🙄

*sigh*


Anyone else care to actually address what Kaplan's saying about a Feeding Tube being a mode of treatment? (aka address the OP) and help "clarify" this for me and help free me of my "silly interjected opinions". 🙄

 

[a winner is you]

Refusing medical treatment that may prolong life is not suicide BY LAW, as has already been said.

 

[Knicks]

Refusing medical treatment that may prolong life is not suicide BY LAW, as has already been said.

it may have already been said, but there was also a whole bunch of irrelevant mumbo-jumbo in his posts that i couldnt weave through all of the nonesense. i didnt bother reading through the rest of his pretentiously "innocent" little posts., wasted enough of my time as it is.

so, what have we concluded? kaplan says that a feeding tube IS in fact a treatment modality, unlike what that other person said (scroll up for proof). anyway, the post above this one clearly and concisely answered the first part of the OP,,,,, Now time for the second part: so what if an uninstitutionalized schizophrenic refuses treatment?

How do we know its not the auditory hallucinations in his head telling him to refuse? and therefore, WHYYYY would a person in such a mental state be allowed to refuse treatment? how/why can such a person be considered "competent"?

EDIT: even FA says that a patient shouldnt make a decision as a result of delusions or hallucinations. So one of these sources has conflicting info, which is why i decided to make this thread, which i thankfully saved from the brink of being hi-jacked.

 

[eduro25]

Hey Knicks , just to complete the answer to your first question , this can only be done if the patient is competent , and that can only be labeled legally.

According to Kaplan and the above posters, we have to assume patients competence , except:

a) Suicide Atempt
b) Patients Physical /Mental State prevents simple communication (I assume here inebriated or severe anoxic brain injuries for example)
c) Grossly Psychotic /Dysfunctional

I think the third one answers your question. Remeber we have a duty to our patients, but legally speaking you also have to protect yourself. If you see an ambulatory patient which is evidently having hallucinations , you write it in his medical chart and label (but not diagnose) him in your mind presumably incompetent. If he refuses to start treatment , then you have the law to back you up and forcefully comit him to a psi institution because of LEGAl non Competence. (which only they can "diagnose").

I hope my answer can help you,
Regards,
Eduro

 

[Knicks]

Hey Knicks , just to complete the answer to your first question , this can only be done if the patient is competent , and that can only be labeled legally.

According to Kaplan and the above posters, we have to assume patients competence , except:

a) Suicide Atempt
b) Patients Physical /Mental State prevents simple communication (I assume here inebriated or severe anoxic brain injuries for example)
c) Grossly Psychotic /Dysfunctional

I think the third one answers your question. Remeber we have a duty to our patients, but legally speaking you also have to protect yourself. If you see an ambulatory patient which is evidently having hallucinations , you write it in his medical chart and label (but not diagnose) him in your mind presumably incompetent. If he refuses to start treatment , then you have the law to back you up and forcefully comit him to a psi institution because of LEGAl non Competence. (which only they can "diagnose").

I hope my answer can help you,
Regards,
Eduro

Hey eduro25,

Thanks for the informative, mature, to-the-point, free-of-witty-remarks type of response. This forum needs more people like you.

Much appreciated. 🙂

 

[McGillGrad]

Hey eduro25,

Thanks for the informative, mature, to-the-point, free-of-witty-remarks type of response. This forum needs more people like you.

Much appreciated. 🙂

YAY!!! You only took 2 days to figure out what most people take 2 minutes to understand. Congrats



This makes me cream my panties!