Informed Consent in Intellectual Disability

[Indodo]

So here is the picture.

Patients with mild, moderate and severe ID (MR/DD if that is what you prefer).
Sometimes they have parents while sometimes they live in board and care facilities.
Usually no POA or conservator (guardian).
They cannot give informed consent themselves.
They need treatment or they will be dangerous to self and/or others. Usually sent to me on ridiculous amount of meds.

Would you treat them. Treat them now but say they need to get the legal set up done or no more treatment. Don't treat them and refer to the ER. Something else?

This is california for the legal scholars.

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[whopper]

Get a guardian.

I'm going to give you two answers on how to proceed. The courts have already ruled that providers aren't supposed to treat a patient that lacks capacity even if they agree to it. That is, for example, if a patient thinks taking a pill will get him into Heaven, so he takes an antipsychotic, no we're not supposed to give him one. The only exception is if the patient is getting treatment because of immediate danger.

The reality, as we know, however, is that most providers will give the antipsychotic, the patient usually clears up, and all is hunky-dory. What I'm talking abut is there was a court case where a patient sign voluntary admission papers believing they were papers that would get him entry into Heaven. He cleared up but was disturbed that providers allowed him to sign papers even knowing he didn't know what he was signing. He sued, the courts made their decision.

So you proceed the way the courts want you to do it or the way most people do it. Mind you I would never, ahem, recommend you do it the way you're not supposed to do it. You're supposed to do it the legal way.

 

[Indodo]

Ok.

So, the vast majority of moderate to severe mentally ******ed/intellectually disabled persons are not conserved (what california calls guardianship) in the US.

Also, the vast majority cannot give informed consent. Medications are usually treating an impulse control disorder, developmental disorder or something and they don't get better like someone who is manic or acutely psychotic would.

Is there any provision here or do all these people need a guardian? Thats a lot of guardians.

 

[whopper]

And it appears that California is doing what pretty much everyone else is doing. They're having the providers give meds to patients that don't know what they're taking, and while this may even be in the patient's best interest, the legal system has already determined this is not appropriate practice, but it continues to go on and on and on.

Yeah it's a lot of guardians, it's impractical, but that's the way it is. You either do the practical and the realistic, or you do the legally appropriate. Most people do the first, though some do it out of sheer laziness. Hey, I guess if you're ever brought to court you could argue it's standard of care---because for better or worse, it is.

There is a healthy compromise. Capacity doesn't mean they understand EVERYTHING. It means they have a general understanding. E.g. they know a med can help them, they know thre are some risks. I'd say, however, that if someone has severe MR, this is pretty much out of the question. Moderate MR, maybe. Mild-yes it's possible, even likely with the proper instruction and education.