Can a doctor overrule patient decisions?

mardybumbum

Hello everybody. Just after finishing my first week of medicine at Trinity and Im loving it, but I need a bit of help. As part of my Problem Based Learning I have to do a bit of research into when a doctor can overrule a patient's decision. Cant seem to find any information via google. Any help would be greatly appreciated.

Vorsprung

The short answer is yes.

A couple scenarios to look up, I'm sure there are more out there but can't think of them right now.

1) Women who are Jehovah's Witnesses who have a primary post-partum haemorrhage and are given a transfusion, or when their new born children need a transfusion - in these cases, transfusions have been given after a speedily granted court order.

2) Involuntary admissions to in-patient psychiatric institutions. Have a look at the Mental Health Act, 2001.

Have a look at the Med Council's Ethics Guide http://www.medicalcouncil.ie/_fileupload/standards/Ethical_Guide_6th_Edition.pdf

sam34

try googling autonomy and paternalism, might throw up more info for you.

in brief, doctors can override a patients decision if the patient is not competent to make that decision in the first place and the treatment/intervention proposed is in the patients best interests- eg, a patient who is sufficiently confused for whatever reason might be refusing all treatment, because they dont understand the nature and purpose of it, however this can be overridden (overrode?). generally, this does not require going to the courts, common law suffices

the converse also applies- ie if the person is competent to make a decision, then no doctor can override it.

RobFowl

bigjimthefirst wrote: »

The short answer is yes.

A couple scenarios to look up, I'm sure there are more out there but can't think of them right now.

1) Women who are Jehovah's Witnesses who have a primary post-partum haemorrhage and are given a transfusion, or when their new born children need a transfusion - in these cases, transfusions have been given after a speedily granted court order.

2) Involuntary admissions to in-patient psychiatric institutions. Have a look at the Mental Health Act, 2001.

Have a look at the Med Council's Ethics Guide http://www.medicalcouncil.ie/_fileupload/standards/Ethical_Guide_6th_Edition.pdf

They Jevhovahs cases are very tricky patinets are entitles to refuse life saving treatmnet but as a general ryle they cannot override treatnwent for their under age childre or confused relatives. This can be done but requires a court order.


involuntary admissions can be challanged by the patinet through the new mental health review bodies

luckat

A funny (if dark) story: a friend of mine, a darling, died recently. He had willed his body to science.

His widow had just left his deathbed and was walking in the corridor, reclaiming her self-possession, when a nurse came up and started trying to get her to sign up for a particular funeral parlour.

"No," she said, "He has arranged that his body will go to medicine, and another funeral parlour [which she named] deals with the arrangements."

The nurse said indignantly: "Has the doctor given his permission for this?"

sam34

RobFowl wrote: »

involuntary admissions can be challanged by the patinet through the new mental health review bodies

yeah.
every patient admitted against their will to a psychiatric unit has a solicitor appointed to them, who represents them at the tribunal. the tribunal automatically happens after a set period of time (usually 21 days). the tribunal can overturn the detention if they see fit. sometimes, in fact, a lot of times, they are overturned on legal technicalities. while this can at times be frustrating to deal with, this in-built review has given patients much more protection, and has brought ireland inline with the European Convention of Human rights, which we were previously breaching when using the old menatl health act.

Johnny Utah

There was a recent successful case brought to the High Court. I'm not sure if it was reported or not, but anyway it was brought by a Jehova's Witness who had not been in a position to consent to or accept life-saving treatment, but the doctors went ahead anyway. Obviously there wasn't enough time to get a court order in this case.

DrIndy

over-ruling someone who is not an emergency is very tricky - but we must think of their best interest - balancing harm of not acting with the harm of acting against their wishes.

Usually this can be thrashed out though by good explanations of risks and benefits.

the trouble often comes from families who have no legal standing at all in ireland. They cannot decide the treatment of an adult, even if mentally incompetent. If we wish to treat a patient against their will if mentally incompetent - we must if we feel it is of benefit, but if their families object - then we are hanging free.

However it is the families who initiate complaints and legal proceedings however and this is a very tricky problem.

Thank God I have not yet treated a jehovahs witness who needed a blood product!