Medical Should medical staff stop when you tell them to?

[FragileGlass]

@Anarchy

I’m a member of the Emergency Unit security team. I follow orders, guidelines and protocol to ensure the safety of all parties from patient to attending emergency personnel are safe. It’s my job. That’s where I get my permission.

A suspected drunk driver extracted from automotive accident that resulted in severe internal haemorrhage attempted to leave unit. Compliance was necessary due to violent behaviour and his refusal to allow staff to do their jobs in saving his life. His first behaviour dictated my response.

 

[ben1982]

You have a incredibly hard job. And you have to make incredibly hard decisions in a short timeframe. I'm sure you have the best intentions. Just as most people who go into the medical field. I'm not in the position to judge this incident. This isn't a personal attack on you. Please don't take it that way.
But maybe there should be a discussion on consent even in some of these cases. Maybe we should ask the question if medical workers have the right to save someone's life against his will? I get people have to be stopped when they are a danger to others. But is it always justified to force people into treatment who are a danger to themselves? Doesn't that take away the right of informed consent? And who and how is this determined? If we only have the right to chose the officially approved choice. That would mean we don't have any choice. It's not the popular choices that need protection by law. It's the unpopular choices. Free will also means the freedom to make the rong choice. And suffering the consequences

 

[gealach]

question if medical workers have the right to save someone's life against his will?

that is a medical-legal question, encountered regularly by front line emergency workers. Hence, the dnr and goc and other similar medical-legal paperwork. It's actually a relief when someone has thought about the care they want & don't want, and have taken the time to complete the paperwork defining their choices. With those legal papers, we can legally do what you want. Without those papers, our hands are medically, ethically, and legally tied, and we are bound to err on the of caution and provide the highest level of care possible.

s it always justified to force people into treatment who are a danger to themselves? Doesn't that take away the right of informed consent? And who and how is this determined?

Actually yes, if someone is a danger to themselves or others then they are no longer mentally competent to make rational decisions. Someone who is not mentally competent, by definition cannot make informed consent for treatment or anything else. This is also a medical-legal issue. The decision is a combination of medical and law enforcement, and requires both under the Mental Health Act. Being "arrested" under the MHA isn't actually an arrest at all, as there is no criminality involved. This is a preventative emergency measure, designed to get the person to medical care, and back to a state where they are no longer a danger, are mentally competent, and can make informed consent. It's not actually a case of "help, help, I'm being repressed" when treatment is enforced against your will here, though it may feel like it in the moment (and keep in mind your brain is in serious crisis here, and incapable of understanding what is happening).

It's been my personal experience, that there is none or very minimal use of physical force by LEO's and medics in the majority of MHA "arrests", because we work really hard to de-escalate verbally first, and use of force is reserved for those who pose serious and immediate threat who cannot de-escalate verbally.

People who are mentally competent and not a danger to self or others, are absolutely free to make their own choices, both right and wrong, and enjoy the consequences of both.

 

[EveHarrington]

You have a incredibly hard job. And you have to make incredibly hard decisions in a short timeframe. I'...

I honestly don’t think this should be changed. Letting people roam free when they are a danger to themselves? No thank you. There is no “good” way to determine who should be free to harm themselves should they do desire and those who are bat shit crazy and don’t know they are harming themselves. The rules are sweeping for a reason, for the safety of ALL.

I can tell you’ve never been in a psych ward, otherwise you’d understand this concept.

 

[Friday]

Maybe we should ask the question if medical workers have the right to save someone's life against his will? I

That’s what a DNR is for.

Do Not Resuscitate.

And there’s a process involved for a person to get one. It’s neither long (takes less than a day, often less than an hour, to file in court), nor complicated (you sign a paper), nor easily challenged. (Loved ones challenge DNRs in court all the time, and they almost never win).

People are strongly warned to wear a medic alert bracelet if they’re not in an acute care setting (a lot, if not most, DNRs are signed whilst in hospital) because in the absence of something telling emergency workers to move on to the next victim, you try and save everyone.

^^^
This falls under saying “no” when it’s not an emergency. Because the decision is being made when lucid, in a calm moment, not when you’re blinded by pain screaming to god and everyone to please just let you die.

People do 3 things when they’re in real pain - beg for their mommy, beg to be saved, beg to die.

As soon as you start moving their torn up bodies around trying TO save them, is usually when they scream at you to stop, and beg to die.

You don’t stop.

 

[FragileGlass]

@ben1982

These practices do exist. People have the right to refuse treatment at the Emergency level, but need to sign a document that they accept their choice to not receive treatment and absolve the hospital from their duties to perform additional services. If they fail to sign this document, leave the hospital and die. Hospital, medical staff, security staff could be liable. There are other restrictions like DNR’s which go beyond my scope of experience as I am not medical staff.

Here in Canada there is also implied consent when a patient is incapacitated, they become unresponsive. Yes, they could technically sign that document to refuse treatment and walk five feet and pass out and get treated all over again.

What you’re suggesting has too many legal and moral complications. Especially in regards to drug / alcohol, varying levels of mental health afflictions and legal age of consent.

 

[Justmehere]

The medical community debates and adjusts far more rapidly than you’ve suggested. There are constant guidline and policy changes almost at a daily pace as we learn how to deal with certain issues.

Except...not really. Not across the board. At least, not in the US.

Practically speaking, my experience is that actual practical across the board change is much more mixed and slower, especially in smaller towns and rural areas, or in understaffed/underpaid clinics and hospitals in the inner city.

Additionally, sometimes the policies can be correct and spot on, and yet it takes time for the culture and practices to catch up. I have friends and family who have worked in medical care share stories of really sh*tty things they have done on the job... not illegal things, but dumb-ass human things.

Health care professionals are people too. The field is neither all bad or all good. It is a mix of the good, bad, and ugly. Just like other professions.

 

[ben1982]

(What you’re suggesting has too many legal and moral complications. Especially in regards to drug / alcohol, varying levels of mental health afflictions and legal age of consent.)
Yes it has. And i'm not even saying it should be one way or the other. I'm just saying there should be a debate about these issues. And not just in the medical professions. But society as a hole should have a debate. These are uncomfortable questions, i realise that. That doesn't mean we shouldn't ask them. In my experience the most uncomfortable questions are often the most meaningful. People avoid these questions because it can be painful to discuss these thing. It's hard to discuss these things. These are complex issues. And people get emotional about it. But does that mean we should avoid it? Or that only a small group of self proclaimed experts should have a say in these very important issues? Isn't it time to question the morality of many things since our world is changing so fast.?
Just asking questions. No conclusions yet.

 

[ben1982]

Just another example. What about circumcision? Has life long consequences. Is done without medical need. And without informed consent of the person. It's illegal on girls but not on boys. And the proof of any health benefits is questionable at best. But the topic is avoided because it causes people to react emotionally.
So? Is there a moral justification for circumcision? Seems a important question to me. Because the consequences are for life. And the boy has no say in it. What about informed consent?

 

[Neverthesame]

I'm circumcised. No particular reason why it was done.
Not Jewish, no history of problems. When I was an infant, people just had it performed on their kids.
Personally, I don't think it's had any effect on me one way or the other.
I was far too young to remember, now as an adult I just don't care.

A cousin of mine on the other hand. He was not circumcised. At around age 12, he developed a problem requiring a circumcision to be performed.
Of all the ages to have a that specific procedure performed? His poor luck it was at the age when we get hardon's every 15 minutes. Damn!

Still I imagine he'd still prefer the circumcision, to difficult, painful urination, that causes frequent urinary tract infections, from not being able to fully empty the bladder.

Information and consent is great and all. But sometimes it just isn't actually practical or helpful. Sorry, but a 5 year old child screaming that they don't want a local anaesthetic because it comes in a needle...
"Sure kid, let's just skip that and go straight to the drilling."
Or leave a compound fracture flopping around, because the kid thinks the cast will clash with her school bag.

 

[FragileGlass]

@ben1982

You’re jumping all over the board with ideas.

I can give you another very difficult consent scenario. A grown woman, with cuts, bruising, fearful behaviour, withdrawn and quick to dismiss assistance with her obviously very present doting and loving partner at her side is very much capable of refusing to give consent as well. Her refusal to consent could be an issue of forced refusal, we as a security team have tactics to deal with these scenarios in order for the patient to get the proper care she needs. Legally we can only go so far, but yeah we try our best to intervene when we can. Consent at face value needed to be questioned. I can assure you, I’ve escorted many domestic partners out of my ER. Happily many of them into the handcuffs of waiting police officers.

I’m not saying conversations shouldn’t happen. With a complex industry such as medical care. There are broad stroke consent policies, where the patient of sound mind is in control of their medical future, reality is, during critical care and emergencies there are far too many grey areas unless pre-drawn legal documents absolve us from our duty to perform.

 

[Friday]

What makes you believe that you, an individual human, are somehow special / entitled enough to have greater rights over another individual human's body than they have?

Just because no one helped you doesn’t mean that the crazy should f*ck the desperate, who should f*ck the good, and no one should help anyone else, ever.

Some people still give a damn about helping others, and protecting others.