Being mentally ill does not mean you are mentally incapable. Plenty of people with mental illness manage to live independently and make decisions for themselves on a regular basis.
In my first statement, by “mentally capable” I mean someone who can otherwise function independently and does not require a power of attorney or guardian to manage things for them.
From all accounts it sounds like the OPs mother was perfectly capable of living and functioning on her own before her stroke. Just because she has issues with anxiety (which are not always psychological, by the way) and depression does NOT mean that she suddenly becomes a second class citizen with no say in her own medical care.
It was the “I need to go sharpen my talons for Monday,” that I was responding to. Sure sounded to me like he was talking about throwing down (metaphorically speaking) with some hospital staff on Monday. Or maybe I’m wrong. Maybe he owns a couple of Eagle Talons and by “sharpen” he meant to polish them up and make 'em all spiffy.
It also doesn’t mean that you are capable. How many more qualifiers did I need to put on that statement to make that clear?
“From all accounts” in this case amounts to a couple of sentences that describe the patient as “psychologically fragile,” “easily frightened”, “prone to chronic anxiety,” prone to depression, and who has now had a couple of massive anxiety attacks after the revelation. It says nowhere in the OP whether the patient lives on her own without help. It also doesn’t say whether she requires a guardian to manage her. I’m not sure where you are gathering your assertions. We don’t know from the given information whether Washoe’s mother was mentally capable or not before her stroke. For all we know she might have been living in a nursing home with round-the-clock care, or perfectly well in her own home on her own for the last 30 years. The information is not there, and I trust that Washoe knows the situation better than he included in his post.
I for one am leery of hiding the reality of someone’s condition from them; if I was that sick I’d wanna know. I’m not going to condone or condemn here since I don’t know the details, but I’m sorry to hear that a monkey wrench has been thrown into the works.
If his mother was living in a nursing home or could not understand/care for herself I think the OP would have said that rather than using such ridiculously vague and condescending terminology such as “psychologically fragile.”
He didn’t say “My mother has a diminished mental capacity and as her guardian her doctors and I decided it was in her best interest not to tell her.”
What he basically said was he didn’t want to scare her because she’s easily frightened so he wasn’t going to tell her. Well, I imagine that being in a hospital and not knowing what is happening to you is a hell of a lot more frightening than knowing what happened and what to expect.
The talons are of a metaphorical nature. We are on our way to see her right now. Some damage control seems inevitable, and we intend to prepare her for the possibility of surgery as delicately as we can. I’m not going to confront anybody until mom is out of the ICU. If my wife wants to rip the RT a new one, that’s up to her.
You know, there are some people who are otherwise mentally capable who will work themselves into a frenzy with just a little prodding (I would imagine that ‘you had a major stroke’ would be a fairly large prod for such a person). It’s not exactly a secret that mindset can greatly help or hinder a patients recovery. For such a person, I would think that temporarily withholding the full information would be better than risking they get so worked up it affects their chances of recovery. I mean, that is the point of being in a hospital, to eventually get better.
That can be quite an if. The woman did have a major stroke - has she been evaluated by a neurologist? A psychiatrist? I have no way to evaluate her mental capabilities. I do know that after her stroke (which I’m guessing was not as bad as Washoe’s mother’s) my mother was not capable of effective communication for a couple months (she did recover that ability). Meanwhile, decisions had to be made.
You seem to be rather resistant to the possibility that perhaps withholding information or dispensing it gradually really might be in the best interests of a particular patient. Certainly not most patients, but there are exceptions.
What if she is not capable of processing the information? What do you do then?
Let’s see… I’m certain they told her she was in the hospital… they told her she fell down and hit her head (also true, I presume… in which case you have to rule out a head injury or concussion in addition to a stroke)… are any of these lies? It is clear to me that they were going to tell her more but wanted to do so in a manner that minimized risk. I am not entirely satisfied with everything in the OP but I also realize it was written by someone who was angry at the time, who didn’t give us all the information, and may have spent years dealing with the mother’s psychological/psychiatric issues. I have no idea how functional this woman was before her stroke. I have no idea how severe her anxiety problems have been over the years. I have no idea what the medical team had or had not agreed upon. Perhaps because I am aware of how many variables come into play I was willing to give the OP some benefit of the doubt. You, clearly, are not. Well, OK, here it is all opinion.
I also have sympathy because my family is currently dealing with my own mother being critically ill - and we don’t know if she is mentally capable or not right now. You’d think that would be an easy question to answer but it isn’t always. We can ask mother’s opinion, but whether or not she answers, whether or not it makes sense, seems a bit random of late. What the hell do we do now? Decisions have to be made. We can’t trust her to act in her own best interests, yet she hasn’t been legally declared incompetent - doing so takes time. Time she may not have. So… what do you do? You sit down with medical people and go over what’s happening and try to do your best, As I said, my mother has made it very clear how she feels about some things and that helps immensely. Did Washoe’s mother do this? I have no idea. I am willing to consider the possibility that an exception to the usual disclosure rules really was in the mother’s best interests in this particular case.
But if the doctors believe that temporarily withholding information from the patient is in the patient’s best interest, then it should be the doctors who make the decision, in consultation with the family. The family should not get to make the decision unilaterally.
Let’s see, she’s been in the ICU for nine days on a vent and in all that time only ONE doctor/nurse/medical professional utters the word “stroke”?
As I said earlier, I have trouble believing that unless the staff also agreed to withhold information. Crap, every time a nurse walks into a room with my mother they do a review of where she is and why, it’s part of keeping patients of questionable mental status oriented.
Regardless, the family has to do damage control now. I wish them luck.
You don’t get to decide to strip someone of their right to know what is going on with their own medical care just because you think they would take it poorly. I mean, fuck, I would expect anyone to react pretty damned poorly if they just found out they had a stroke.
I see no justification that makes this any less disgusting behavior and quite frankly I’m shocked that so many of you consider this anything less than reprehensible. Thank God I’m not related to any of you.
All I’m saying is that maybe she would prefer not to know. No one is going to take it particularly well getting that kind of information, but some take it worse than others. If it were you, you might simply absorb the information and concentrate on getting better. Someone else might start imagining all kind of horrible things that they think might happen, to the point that it might seriously fuck up their chances of recovery (which, in this case, seems to have happened).
Some people like knowing everything that is going on. Some people prefer working on a need to know basis. We have no idea which the OPs mother is, but the family made the decision (with a firmer basis to work on that either of us have here) that the latter approach would result in better chances of recovery.
And it’s precisely because I too am in this exact situation with my own mother that I find comments like yours and the OP’s so disgusting. My mom had a major strok e in September and we are now facing the possibility of a brain aneurysm. She is also showing signs of dementia or Alzheimers. I watched her mother, my grandmother, waste away from Alzheimers for 13 years. So please don’t pull that “You don’t understand the complexity of the situation” bullshit with me.
When I sat in the neuro ICU with my mother, barely conscious and hooked up to dozens of monitors and tubes, my biggest fear for her is that she would be scared to death because she didn’t know what had happened. And it was the knowledge, the understanding of what had happened, and learning what she could to do take control of her recovery that gave her the strength she needed to keep her spirits high. It was knowing that her family and doctors and friends all cared enough to give her the support and knowledge and power to help her through recovery that has helped her heal.
Keeping someone in the dark and not involving them in decisions about their own care only fosters more fear and helplessness. I can’t see how on earth anyone could consider that conducive to healing.
Using my own grandmother as an example it was when she had trouble remembering who her son was, who her grandchildren were, or that she was a women in her 70s and not a 7 year old girl.
How is scaring someone so much that they worry themselves to death the right choice? That sounds like exactly what Washoe wanted to prevent, and what may yet happen.
I don’t know the OP from a hole in the head. However, I have more faith in him to decide which would be best for his mother than I do in you.
I’m not. You don’t seem capable of distinguishing between “Complex situation” and “different people come to different conclusions than you”.
Your mother’s situation is your mother’s situation. My mother’s situation is her situation. Washoe’s mother’s situation is a third situation. While they have some things in common they all involved different details and, more to the point, different people.
My mother, unlike yours, does NOT have Alzheimer’s. That alone is a significant difference (and one I was not aware of until your most recent post). My mother, horribly enough, during her lucid times is completely cognizant of the fact that sometimes she is NOT competent to make decisions on her own behalf. She has not only handed my father authority to make decisions when she is not capable she has also handed him the authority to make that determination. This does, of course, require an enormous level of trust in her husband.
I am not and will not question your actions in regards to your mother because you know her situation far better than I do. Please do not question my actions in regards to my mother, for the same reasons. As I said, I am willing to grant Washoe the benefit of the doubt because I don’t know all the details there, either. If her mother had broken her hip (as an example) I’d question withholding information at all, but between a stroke, psychiatric history, and possible head injury extra caution in disclosing information may be entirely appropriate in this situation.
That’s a situation that would require a legal power of attorney or guardian to help manage decisions about health care. Even so, I wouldn’t dream of not telling someone what had happened to them or what was going to happen. Whether the patient is in a state where they are able to make decisions about their health care they should at least have the right to know what is going on, even if they don’t understand it.
My husband was a case worker for many, many years to people with mental handicaps of all sorts and even if the client had little comprehension of their surroundings, he still had a duty to inform them of what was happening with their medical care.
People are different but the ethical concept of an individual having informed consent is not something that you can take on a case by case basis.
You don’t get to decide to strip someone of their basic right to information about their own health care just because they may react differently. Your mother has made that choice for herself - so she has been informed and made a decision based on that information. She knows what is happening to her (even if she doesn’t know it all the time).
My point is and always has been that regardless of the patient’s psychological state they deserve to know what is happening to them. If they choose, or are incapable of making decisions based on that information THEN the family and doctors should work together to determine the best course of action. But the patient deserves to know what is going on - or at the very least deserves to be able to make the decision of their own accord to have that information withheld.
And, because this is the SDMB, here’s a cite from the AMA:
www.ama-assn.org/ama1/pub/upload/mm/369/ceja_recs_2a06.pdf
“Withholding pertinent medical information from patients under the belief that disclosure is
medically contraindicated, a practice known as “therapeutic privilege,” creates a conflict
between the physician’s obligations to promote patients’ welfare and respect for their autonomy
by communicating truthfully.”
“Withholding medical information from patients without their knowledge or consent is ethically
unacceptable.”
and:
"Physicians may consider delaying disclosure only if early communication is clearly
contraindicated. Physicians should continue to monitor the patient carefully and offer complete
disclosure when the patient is able to decide whether or not to receive this information. This
should be done according to a definite plan, so that disclosure is not permanently delayed. "
If the OP’s mother had, herself, said she did not wish to be informed then I see no problem with the situation. The OP does not state that, however.