Ethical question: Would a pt with schizophrenia would be forced to treatment?

[Bookmark311]

If they are not compromising their own safety or others safety?

[m_jacob_45]

Yes they could if it’s deemed that their condition is making them unable to make decisions about their own care. 

[aaronahc]

For any patient, unless it is an emergency situation, you cannot simply force treatment on them. Here, there are several options. I would first determine if this patient is competent. Each person's condition is unique and just because they have a mental illness may not necessarily mean that they are incompetent. Next, I would look for a SDM or any advanced directives. In the event that all of these are unavailable, I would consult my colleagues or a senior physician to discuss. Drugs always have side effects and if you cannot be sure a patient is okay with them, you cannot just assume they will be. Let's say the individual is cured of schizophrenia but treatment has made them blind, they might have preferred to stay in their previous state. 

[JohnGrisham]

On 1/17/2019 at 8:22 PM, m_jacob_45 said:

Yes they could if it’s deemed that their condition is making them unable to make decisions about their own care. 

"unable to make decisions about their own care"

Generalization. Most often, you can't force medical decisions on those with psychiatric conditions.   Yes, you can force admit and treat for psychiatric conditions. But you can't often force them to get their diabetes under control, etc unless its a medical emergency scenario. 

It is very difficult in actuality to force treatments onto those with psychiatric diagnoses. 

[m_jacob_45]

8 hours ago, JohnGrisham said:

"unable to make decisions about their own care"

Generalization. Most often, you can't force medical decisions on those with psychiatric conditions.   Yes, you can force admit and treat for psychiatric conditions. But you can't often force them to get their diabetes under control, etc unless its a medical emergency scenario. 

It is very difficult in actuality to force treatments onto those with psychiatric diagnoses. 

I was commenting based on my clinical experience. We did have to force treatment/admission on a patient with new onset highly psychotic schizophrenia unfortunately when I rotated through psych emerge. Only psych issues were the focus of treatment. We did not force him to deal with any other medical conditions. Obviously it is not a preferable option and really only done when the patient’s own delusions/hallucinations are making them unable to make decisions due to things like paranoia. 

[m_jacob_45]

9 hours ago, aaronahc said:

For any patient, unless it is an emergency situation, you cannot simply force treatment on them. Here, there are several options. I would first determine if this patient is competent. Each person's condition is unique and just because they have a mental illness may not necessarily mean that they are incompetent. Next, I would look for a SDM or any advanced directives. In the event that all of these are unavailable, I would consult my colleagues or a senior physician to discuss. Drugs always have side effects and if you cannot be sure a patient is okay with them, you cannot just assume they will be. Let's say the individual is cured of schizophrenia but treatment has made them blind, they might have preferred to stay in their previous state. 

See my response to John Grisham below for further information if you’re interested.

[JohnGrisham]

3 hours ago, m_jacob_45 said:

I was commenting based on my clinical experience. We did have to force treatment/admission on a patient with new onset highly psychotic schizophrenia unfortunately when I rotated through psych emerge. Only psych issues were the focus of treatment. We did not force him to deal with any other medical conditions. Obviously it is not a preferable option and really only done when the patient’s own delusions/hallucinations are making them unable to make decisions due to things like paranoia. 

Yes correct for psychiatric issues. I misinterpreted your statement referring to medical treatments.