coerced treatment

[Marco Anglesio]

On Wed, 13 Jun 2001, Marta Russell wrote:
> in advancing their own interest all of the time" but if you were
> subjected to a medication that was giving you harmful side effects
> would you say "I can't advance my own interest because not everyone
> can, so therefore I will continue to take this harmful drug?"  Of
> course not. Converting all action to one narrow view as though it must

It is rather difficult to adopt a long-term view in such cases, especially
when the balance of harm is based on a balance of probabilities. For
example, a drug may have nasty adverse effects (and many do - from tardive
dyskinesia with the major tranquilizers or fatigue and nausea with
lithium) but still end up benefitting the patient. 

That said, the patient still has to live with the side effects, and that
can be very taxing. Drug discontinuation is a major problem for those who
suffer from such mental illnesses as depression, manic-depression, or
schizophrenia. For the latter two, the consequences of drug
discontinuation can be quite severe.

The grey area is even moreso when one considers more controversial
therapies, such as ECT. Having done some lay research, I wouldn't assert
that ECT is not of therapeutic value, but the adverse effects can be very
bad. It might be worth noting that ECT is rarely administered as
prophylaxis, but most often to deal with an acute and severe episode.


> understand quadriplegia, for instance, often will put a quad in harm's
> way by not knowing details the quad does know.  You should see how

That's an imperfect metaphor, given that mental illness does affect one's
perception and cognition, sometimes quite severly, while quadriplegia does
not.

Don't take this as wholeheartedly disagreeing with you, Marta, because I'm
not. Doctors are by no means infallible, and they are never miracle
workers; even the very competent ones occasionally guess wrong, or fumble
with a lack of information and pressure to produce results.

I am unsure of the right course of action, but I do think that in the case
of severe mental illness, the right of a patient to decline treatment
should be somewhat limited. Perhaps those jurisdictions who grant it to an
ombudsman are on the right track. 

My (very occasional) 0.02$ worth.

Marco

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>                                 |      Do not use that foreign word      <
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