Ethics fun

[Wiggy73]

Hey guys, I see a lot of people on here always asking for ethics questions to help them practice for interviews, so I thought I'd throw out this one from Vanderbilt's Ecology of Health Care first-year course. If you like it there are more where this came from. Take it away, SDN!

A 22-year-old black man was charged with assault after attacking two police officers who confronted him on a midnight stroll. A court-ordered psychiatric evaluation diagnosed him with paranoid schizophrenia and incompetent to stand trial. He was therefore committed to a state mental hospital for treatment until found competent to stand trial. However, the man refused the prescribed medication on several occasions. He was usually clear and adamant about this, stating that he understands that the doctors believe he needs the medication, but he didn't want any medication that would alter his brain. The doctor in charge believes forced medication would improve the situation.

Should forced medication be allowed in this situation?

The lawyer representing the man believes that he would receive a very short prison term if convicted but may face commitment for 4 years under state laws if he fails to stand trial.

Does the lawyer's opinion affect your decision?

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[ShyRem]

This comes down to the question of does the man have the right to refuse medication? Is he competent to refuse medication? Or just not competent to stand trial? If the man is competent to make medical decisions, then he is able to refuse medication. The lawyer's opinion has no bearing on the medical aspect of this case.

 

[mercaptovizadeh]

Hey guys, I see a lot of people on here always asking for ethics questions to help them practice for interviews, so I thought I'd throw out this one from Vanderbilt's Ecology of Health Care first-year course. If you like it there are more where this came from. Take it away, SDN!

A 22-year-old black man was charged with assault after attacking two police officers who confronted him on a midnight stroll. A court-ordered psychiatric evaluation diagnosed him with paranoid schizophrenia and incompetent to stand trial. He was therefore committed to a state mental hospital for treatment until found competent to stand trial. However, the man refused the prescribed medication on several occasions. He was usually clear and adamant about this, stating that he understands that the doctors believe he needs the medication, but he didn't want any medication that would alter his brain. The doctor in charge believes forced medication would improve the situation.

Should forced medication be allowed in this situation?

The lawyer representing the man believes that he would receive a very short prison term if convicted but may face commitment for 4 years under state laws if he fails to stand trial.

Does the lawyer's opinion affect your decision?

The lawyer's opinion is irrelevant.

Also, you should not force the medications for the man. He is obviously not incompetent, and besides, mental illness doesn't exist, so its a moot point.

 

[place]

and besides, mental illness doesn't exist, so its a moot point.

Ok, Tom Cruise

 

[Rendar5]

...

 

[Wahina]

Ok, Tom Cruise

YOU don't know the history of psychiatry. I DO.

 

[place]

YOU don't know the history of psychiatry. I DO.

please explain.. (you are right, I dont know about the history of psychiatry). I will listen with an open mind.

 

[Rendar5]

please explain.. (you are right, I dont know about the history of psychiatry). I will listen with an open mind.

I think he was referencing Tom Cruise
(though the history of psychiatry is not that great, lol. it's continually 100 years behind medicine. so it always seems out of whack)

 

[place]

I think he was referencing Tom Cruise
(though the history of psychiatry is not that great, lol. it's continually 100 years behind medicine. so it always seems out of whack)

haha, i didnt actually see the tom cruise interview so i didnt catch the irony

 

[67192]

Hey guys, I see a lot of people on here always asking for ethics questions to help them practice for interviews, so I thought I'd throw out this one from Vanderbilt's Ecology of Health Care first-year course. If you like it there are more where this came from. Take it away, SDN!

A 22-year-old black man was charged with assault after attacking two police officers who confronted him on a midnight stroll. A court-ordered psychiatric evaluation diagnosed him with paranoid schizophrenia and incompetent to stand trial. He was therefore committed to a state mental hospital for treatment until found competent to stand trial. However, the man refused the prescribed medication on several occasions. He was usually clear and adamant about this, stating that he understands that the doctors believe he needs the medication, but he didn't want any medication that would alter his brain. The doctor in charge believes forced medication would improve the situation.

Should forced medication be allowed in this situation?

The lawyer representing the man believes that he would receive a very short prison term if convicted but may face commitment for 4 years under state laws if he fails to stand trial.

Does the lawyer's opinion affect your decision?

I would say that if he is paranoid schizophrenic, he is not in a state of mind to be making decisions on his own... thus the man should be made to take his medication. I think the lawyers opinion does carry some wait, b/c as a physician, we should be concerned about the overall well-being of the patient. The most fair/just thing for the patient is to be able to stand trial in a sound state-of-mind and our role (as future physicians) is to give this man his sound state-of-mind.

 

[LabMonster]

However, the man refused the prescribed medication on several occasions. He was usually clear and adamant about this, stating that he understands that the doctors believe he needs the medication, but he didn't want any medication that would alter his brain.

I agree, the lawyer's opinion is irrelevant. The above excerpt highlights the patient's paranoia, which will, in a vicious cycle, keep repeating itself because the patient is not mentally competant to make rational decisions on his own. Let the patient refuse, and be committed. Long term care may be the only solution to slowly reforming this mans psyche - changing it enough so he realizes medication may benefit him.

A short prison term would sound good, but what happens when he gets out? Will he have a place to stay? Money? A job? A treatment program? Odds are he would be arrested within a month.

Bottom line, he needs treatment, and the best way to do that is long term therapy.

 

[Shredder]

The lawyer's opinion is irrelevant.

Also, you should not force the medications for the man. He is obviously not incompetent, and besides, mental illness doesn't exist, so its a moot point.

dont force it

 

[deuist]

A good place to loof for cases is bioethics.net

 

[nontrad314]

A good place to loof for cases is bioethics.net

Great link

P.S. I owe you some notes. Some will be available shortly.

 

[WhatUpDoc!]

A 22-year-old black man was charged with assault after attacking two police officers who confronted him on a midnight stroll.

OMG!!! Black man on a midnight stroll... he's probably about to initiate a drug deal... Roger that Sycamore... I think he's packing!!! I'm sorry, but I just love how the race of the so-called "attacker" was given, but the police officers are just... well... police officers.... what a country

 

[mercaptovizadeh]

OMG!!! Black man on a midnight stroll... he's probably about to initiate a drug deal... Roger that Sycamore... I think he's packing!!! I'm sorry, but I just love how the race of the so-called "attacker" was given, but the police officers are just... well... police officers.... what a country

The race of the attacker is morally irrelevant. It is relevant only for a racist profiler or a liberal affirmative action afficionado ("We should have understanding for his crime - afterall, he's black") in which case it is condescendingly racist. Either way, it ain't pretty.

 

[indo]

YOU don't know the history of psychiatry. I DO.

Pre-med E-rule #233: Recent pop culture references that are not most commonly found on the internet will not be understood. However, any reference to "all your base are belong to us" will be laughed at hysterically (roflmao) for at least 10 years.

 

[DentalGal]

Hey guys, I see a lot of people on here always asking for ethics questions to help them practice for interviews, so I thought I'd throw out this one from Vanderbilt's Ecology of Health Care first-year course. If you like it there are more where this came from. Take it away, SDN!

A 22-year-old black man was charged with assault after attacking two police officers who confronted him on a midnight stroll. A court-ordered psychiatric evaluation diagnosed him with paranoid schizophrenia and incompetent to stand trial. He was therefore committed to a state mental hospital for treatment until found competent to stand trial. However, the man refused the prescribed medication on several occasions. He was usually clear and adamant about this, stating that he understands that the doctors believe he needs the medication, but he didn't want any medication that would alter his brain. The doctor in charge believes forced medication would improve the situation.

Should forced medication be allowed in this situation?

The lawyer representing the man believes that he would receive a very short prison term if convicted but may face commitment for 4 years under state laws if he fails to stand trial.

Does the lawyer's opinion affect your decision?

My answer to this is that you can't force the man to take medication that he doesn't want to take. He has to help himself. You can't force medication on someone against their will, even if it would work toward their benefit. What the lawyer said would help me determine what would be in the man's best interest, but in no way could I force anything on him.

 

[WhatUpDoc!]

Either way, it ain't pretty.

Roger that

 

[radioh3ad]

a patient has a right to informed consent. not sure if he is in the right mind to have informed consent, but he seemed clearminded and consistently adamant about not taking brain altering drugs.

the lawyer's opinion is irrelevant to how the doctor should treat the patient.

but i've never taken an ethics course. any answers wiggy?

 

[Centinel]

You can't just dismiss the lawyer's opinion offhand. An autonomous patient does retain the right to refuse medication. Is this patient fully autonomous? Has his disease compromised his judgment? If the bulk of the medical evidence suggests that he is completely incompetent, causing him to take his medication may be a legal requirement. However, if he is found to be cogent, as is suggested by the story, I cannot imagine trying to force him to take his medication. However, should this be the case, he is likely competent to stand trial and should do so.

 

[radioh3ad]

You can't just dismiss the lawyer's opinion offhand. An autonomous patient does retain the right to refuse medication. Is this patient fully autonomous? Has his disease compromised his judgment? If the bulk of the medical evidence suggests that he is completely incompetent, causing him to take his medication may be a legal requirement. However, if he is found to be cogent, as is suggested by the story, I cannot imagine trying to force him to take his medication. However, should this be the case, he is likely competent to stand trial and should do so.

is competence for informed consent the same as competence to stand trial?

 

[maxflash04]

The OP's post reminds me of last week's episode of House for some odd reason...

African American doctor prescribed an African American some medicine that's specifically designed for African American's and some how he refused it; the patient wanted the regularly medicine prescribed to all races because he felt that medicine designed for his race was racism. I'm not going to go into the details because quite frankly, I don't remember and it's not relevant to this topic but I thought it was an interesting one.

 

[Centinel]

is competence for informed consent the same as competence to stand trial?

That is a great question. I don't actually know how competence to stand trial is determined. Can anyone help us out here?

 

[Golddanboy]

I would say theres a strong case to force the medicine. Simply by having the disease, the man should have the right to refuse medication. However the disease has shown to be a risk to others. The punishment for breaking the law is the loss of the right to freedom and choice including what medications he has to take.

 

[prana_md]

I wonder if this hypothetical patient is refusing to be medicated in order to avoid prosecution, or actually doesn't want to be medicated. I think it's sad that he has to forego treatment because the threat of a criminal trial. I wonder if there would be some way for him to serve his regular sentence for assault under the care of psychiatrists in a psych hospital? Something like the law in CA that allows minor drug offenders to "do time" in rehab instead of jail. Prison is definitely not the place for a paranoid schizophrenic, medicated or not.