Doctors Should Treat the Mentally Ill Without Consent

Doctors Should Treat the Mentally Ill Without Consent

Recently, I’ve come across several groups on Facebook and elsewhere that claim to be for the rights of the mentally ill. They talk about defending their rights through lawsuits, funding and online campaigns. They also support the banning of a doctor’s rights to give psychotropic medication / psychiatric treatment without consent. These are either well-intentioned people with little grasp of logic or just plain anti-psychiatry nutjobs.

I admit, I fell for one of these groups on first glance. But upon further reflection and research I’ve come to the conclusion that at best, these people are well-intentioned with little grasp of logic, and at worst just plain anti-psychiatry nutjobs.

Doctors Give Medical Treatment Without Consent All the Time

Consider this, if a person comes into the ER unconscious, the doctors do whatever it takes to save that person’s life. No matter what has happened to them, or what their diagnosis might be, the doctors try to save them. The patient cannot give consent. They are unconscious. This treatment might, in fact, kill the person, but the doctors try their best even though the person is not able to give consent at that time. (There are legal exceptions to this like a do not resuscitate order, but those are the exceptions.) Doctors make hard decisions. They do it all the time. It’s their job.

Doctors do this because it’s their job to do what is in the patient’s best interest to the best of their abilities. That’s why we have doctors. We have them because these people know how to make complicated decisions that we can’t make ourselves. They went to a decade (or more) of school for just this reason.

Why Shouldn’t A Doctor Care for the Mentally Ill the Same Way?

When a mentally ill person is incapable of giving consent due to disease, doctors should be able to treat them without consent just like with any other disease.

Now consider the following, a person is brought into the ER, probably by the police, in a psychotic episode. This person might have been running around naked, or screaming into the air, or otherwise behaving erratically, possibly dangerously, and clearly unwell. This person does not have the ability to give consent to medical treatment. Their mind is currently not their own. They are a danger to themselves, and possibly others. (That is how they ended up in the ER in the first place. If they weren’t a threat, they wouldn’t be there.) The patient is screaming not to give them medication in between threatening the ceiling tiles.

If A Mentally Ill Person Can’t Give Consent, the Doctor Has Only Three Options

Theoretically, the doctor has three options.

  1. The doctor releases the patient. The patient doesn’t want treatment, so they are released. The person though is possibly a danger to themselves or others, so the police may have to act – not good for the mentally ill person. Even if the police don’t, the person can easily do any number of horrible things before they come out of their psychotic episode. The person might die. The person might hurt someone else. Believe it or not, many doctors care about that stuff.
  2. The doctor can put the person in a padded room and leave them there until they come out of their psychotic state. This would likely be without their consent too, but doesn’t involve any type of “treatment” per se. But how long is reasonable to leave a person restrained or in a padded room? What are doctors supposed to do with that person? Health care workers are supposed to somehow attend to the person’s needs like for food, water, and going to the bathroom all while the person is tied to a bed, or in a cell-like room? That sounds ridiculous, impossibly difficult for health care staff, and not particularly humane.
  3. The doctor can treat the person. Yes, this means medication. Probably a fairly heavy antipsychotic to calm the person down so they aren’t a danger to anyone around them and to bring them out of the psychosis.

Are you really suggesting that one or two is better than three?

Not Medicating People Without Consent Only Sounds Like a Good Idea

See, not medicating people without consent sounds like a good idea, but in the real world, it just doesn’t work. It doesn’t work because we don’t have any better ideas. If it were simply a matter of blinking them into safe sanity I would be all for it, but so far we haven’t developed genie technology. No one likes the idea of medicating someone against their will. But mental illness is hard. Many time there are no other options.

I agree that once a person is stabilized and can once again appreciate their situation, they can choose not to consent to further treatment. I’m not suggesting they be medicated forever. And quite frankly if the person were to never leave their house and never hurt themselves, they could be as crazy as they liked with no bother from me or anyone else. But when you show up in an ER insistent on killing yourself or threatening to stab the blue men sitting on your shoulders, something has to be done. If there was no problem you wouldn’t be in the ER in the first place.

No one likes to have anything done against their will, I get that. Me neither. But just like you might be in a horrible accident only to wake up and find your arm amputated out of medical necessity, you also might find that after losing touch with reality you might wake up to find yourself medicated. This is a bad solution, but again, I’m not hearing any better ideas. No one wanted to amputate an arm, and no one wanted to medicate the person either.

[There is this sneaky belief that doctors want to medicate their patients. That they take secret pleasure in forcing coloured tablets down a person’s throat. I don’t believe this to be true. While there’s certainly no accounting for everyone, I don’t think anyone is satisfied with that solution; it’s just that we don’t have a better one.]

So yes, it’s stupid to think that doctors shouldn’t be able to medicate you without consent.

That is their job, in the case of mental illness and in the case of any illness. So the next time someone spouts off against the evil doctors prescribing evil medications I suggest you ask them what they want the doctor to do after they have a heart attack and their heart has stopped. I mean, you wouldn’t want hundreds of joules of electricity to be pumped into your chest without prior consent; that would just be inhumane.

This argument, by the way, completely glosses over all the legal ramifications of consent, which I did on purpose, as I’m not a lawyer. I will say though that medicating a person without consent isn’t an easy as suggested above particularly when lawyers take an interest.

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