We ask people with impaired reason to consent to treatment to try to re-establish their sanity. Are they even capable of making such a decision?
I was psychotically manic, suicidal, and engaging in self-injury when my doctor decided I needed electro-convulsive therapy. I got it. I received a couple dozen treatments that messed with my memory but did stop the episode that nearly killed me.
Somehow, at this time in my life when I was a raving lunatic, I was asked to consent to treatment and, apparently, I did.
Informed consent is crucial to helping a patient maintain their liberty and their rights. No doctor on anyone else’s orders, except in very rare legal decisions, can come along and force a person into treatment. But what if the person should be forced into treatment?
If we are in sound mind we are our own agents. Only we can agree to our own medical treatment. Of course, we can just as easily say no to treatments doctors and family members think will help us.
During my worst mixed-episodes I was not in sound mind. But the doctors still relied on me to make the decisions about my care. Does this even make sense?
I’m a strict civil libertarian. The idea that a person could be forced into treatment scares me. But being crazy was a lot scarier. What if I had said no to the treatments recommended? Like the time I stopped taking my meds and ended up attempting suicide.
I made a decision that was pretty stupid. We all do. That’s how we learn. But after the suicide attempt failed I was given a new treatment plan I had to comply with, by choice. No one could force it on me. Again, I was not in my right mind and probably couldn’t even understand the information given to me about the recommended treatment or its risks. But it remained my choice and my decision.
Can consent truly be informed consent if the person cannot understand the information?
For those with moderate mental illness this seems like a distant issue, and they wouldn’t even entertain the idea that someone else should make decisions for them, and force treatment upon them. But for those with serious mental illness this is a lot more than an intellectual exercise about legal boundaries.
It’s a matter of life and death.
Many families are shut out from getting proper care for their loved ones when the sick family member refuses to consent to treatment. Laws requiring informed consent, and HIPPA laws, make it unreasonably difficult to get someone into something as helpful as assisted outpatient treatment against their will.
Treatment works, but it must be administered. And to be administered, someone has to agree to it.
Families trying to get their loved ones with serious mental illness into treatment face damaging and expensive legal hurdles just to help. All too often, the family member they sought to help winds up on the street, or worse: in prison, where treatment can be forced on them.
Does it have to be this way? Are those of us who manage our mental illness well, and lobby hard to help patients maintain their liberty and keep control of their treatment, partially responsible for the masses of people with serious mental illness that could be treated who are languishing on the street or behind bars?
I think we are.
We insist that treatment only be given with informed consent, even if the patient is not of mind to understand, or to consent to, the treatment.
Yes, allowing treatment without consent could be a slippery slope. Dystopian stories of mind control fly around while simple people with real problems suffer. Proper safeguards can be built into any efforts towards forced treatment, or any suspension of informed consent regulations.
Somewhere between people unnecessarily leading painful, desperate lives and people mandating self-determination there must be some common ground. Unfortunately, that ground is now littered with thousands of people with serious mental illness who could be helped if only treatment were given to them.
Should the right of an unstable, mentally impaired person to choose squalor overrule a family’s, or society’s, right to intervene on their behalf? Should we continue to allow people without reason to consent to their own demise?