I’ve already done the defending of it. She isn’t risking anyone else’s life. She should be able to refuse treatment.
It sucks that not everyone wants medical treatment for whatever reason and it’s even worse that some people want treatment and can’t afford it. What isn’t okay is to take an adult and force them to have medical procedures that they do not want, especially procedures that are major surgery that reach into very personal areas of life like reproduction. There’s no other way I can phrase this. If you reject it, you reject it.
Even if the refusal is based on delusions and mental illness? Why in heavens name are you so keen on letting a mentally ill person die?
You simply continue to ignore the fact that a decision based on a mental illness, is not a true decision at all. Despite your poor attempts to intimate otherwise, I’m all for people controlling their own medical decisionmaking. But not when that decision is because of mental illness.
To some extent we (the societal “we”) owe it to those who are profoundly mentally ill to keep them from making obvious mistakes. But at some point surely we must bow to autonomy—what if this woman never recovers? Are we metaphorically to lock her away, throw out the key, in the name of her own good?
I don’t see how believing, sadly, that there is only so much that we can do to protect the mentally ill implies a “keen[ness to] let a mentally ill person die”. (Sheesh!)
Perhaps a sidetrack: What, specifically, is it about the woman’s mental illness that makes her decision not a true decision? One cannot ever make a decision while in possession of a complete set of relevant facts, uncolored by personal bias, with true knowledge of the consequences from each alternative. We all believe things that are not strictly speaking true. Her belief that god has cured her makes the counterfactualism much more obvious in this scenario, agreed, but would you argue that there is some discernible cutoff beyond which we can say “Yes, any more a denial of reality than that, and you’re incapable even in principle of making a choice”? That seems woolly to me.
Because death is not the worst thing that can happen to a person and her body belongs to her. She should be offered treatment, both for the cancer and for the mental illness (if it exists). If she refuses treatment, she will probably die. I don’t want her dead, but I also don’t want her to be forced into a medical treatment against her will that is not a matter of an emergent situation with no possibility of discovering her wishes before taking action.
I’m not ignoring it; I’m disagreeing with it. They are in the best position to make the decision because they are the ones who have to live with, or die by, the decision.
Yes, she will likely die without the procedure. Yes, that’s a shame. No, I don’t think, “You must live even if you don’t want to!” It doesn’t matter what, barring very temporary situations like a drug high or the like where behavior becomes wildly unpredictable, has caused the decision that living under condition X is worse than dying, but everyone has a point where they would make that. Hers isn’t the same place mine is, but that’s hardly surprising since she’s not me.
Who is the intervention for?
Define mental illness. What counts and what doesn’t? If anyone wants to die are they of necessity mentally ill? How mentally ill is “mentally ill”? If you’ve ever had depression are you mentally ill? If you have it now are you mentally ill? How about anxiety? How about a phobia? If you eat M&Ms by color, are you? If she’s mentally ill and you force her to have surgery, is that going to improve her life? If someone refuses treatment for cancer is the presumption that they are mentally ill? If she just believes God will cure her but realizes she might die without medical treatment, is that mental illness? If she doesn’t trust medicine, is that mental illness? If she goes to work every day and cares for her aging mother and no one ever would think there was anything wrong until the day she says she doesn’t want a hysterectomy, is she mentally ill? Is anyone NOT mentally ill? There are lots of things people have been called mentally ill for in the past that are now considered normal. Were they mentally ill then and got cured? Could doctors be wrong about her prognosis? Could they be wrong about her mental illness? If she got this surgery, was released from the hospital and went home and killed herself because she didn’t want to go on living after being sterilized, would the treatment have been a success? Who benefits when someone is forced to have medical treatment they don’t want? Is there a level of medical treatment you consider unreasonable? Is there any treatment you would refuse for yourself? Would you live as a brain in a jar? If the doctors wanted to perform a hysterectomy and cut off both her legs and both of her arms for cancer, would that still be a reasonable intervention? If someone has an untreatable mental condition should they be put into mental institutions forever? Is she allowed to drink if she’s too incompetent to make medical decisions? Is she allowed to have sex? Is she allowed to vote? Is she allowed to eat Twinkies? Is she allowed to smoke? Should doctors be able to take my rights away? If someone has a long life in a vegetative state to look forward to, should there be massive medical intervention to keep them alive? If this woman signed a DNR and a living will stating she doesn’t want intervention in the case of an emergency, does that count for anything? Is there anything we shouldn’t be able to do to people who are mentally ill? Can we do anything so long as we get a court order? Are self-destructive tendencies mental illness? Can you save everyone? Does everyone want to be saved? Who pays for a treatment the patient doesn’t want? Should the patient be forced to pay for it? Are people ever allowed to say they don’t want to live under certain circumstances? What are those circumstances? Should people who want to live have higher priority when it comes to allocating resources? We have rationing in this country for health care; should it go to people who don’t want the care? What about the people who are denied care because they can’t afford it? Do mentally ill people still have wants and dreams and desires? Do these wants and dreams and desires matter, or is the fact that they are alive all that counts?
Hamlet, what level of mental illness justifies taking away a person’s right to refuse treatment? Treated depression? Untreated depression? How about a personality disorder?
I’ve gone to court to get orders to treat incompetent patients in the past, and I hate it, and it’s not pretty, and we only do it if there’s more at risk that just the patient’s life.
How about a patient with renal failure who needs dialysis to continue living? The patient doesn’t like the idea of dialysis, and besides, God told her he’d take care of the problem for her. Do you want her forced to sit in a chair connected to a dialysis machine for 4-5 hours at a time, 3 days a week? Should we strap her in? Hold her down? Chemically control her if necessary?
How about the end-stage cancer patient who is now incompetent due to brain metastases? He’d indicated earlier he didn’t want to prolong his life if he lost his mind, but his medical power of attorney (now activated due to the patient’s incapacity) wants everything done. Chemo, radiation, and so forth. What do we do?
I’ve had to deal with both those issues, and others, in the past. And I believe we have to set the bar very, very high if we’re going to overrule a person’s right to autonomy in their own body. And to me, merely having a mental illness doesn’t cut it.
Patients deemed incompetent should have a medical power of attorney designated to make their decisions for them, or a guardianship arranged if the former is not done before they become incompetent. But then the decision belongs to the POA or the guardian, and should be made based on patient wishes as much as possible.
Its not that, necesarily. Its that she thinks she is already cured when she is demonstrably not cured. If she said “I have cancer but I would rather die than havea hysterectomy” or " I have faith that God will cure me so I will trust in God and not in your science" then I think you might be right but I thought she thought that she had already been cured.
Part of the issue is the terms that God uses and the terms we use cause misunderstandings. Unfortunately she got caught up in speaking a heavenly language to a worldly court.
When God says He has done something, such as He has cured the cancer, it could mean, by our definition, it is cured today and will not show up on medical tests, however in God-speak translated to our world’s words it also could simply means that nothing (no angel, no demon or devil, no child of God) is going to stop the cancer from being cured.
Though admittedly the cure may be the medical treatment that she is being forced to undergo.
You said you support the right of people to commit suicide. So, I’d guess you’d support the right of a person to drink a glass of poison.
That’s fine with me. What about if that person was absolutely convinced the poison was a glass of lemonade? Would you stand by and let her drink it then?
This person doesn’t appear to be making a choice to die, she is absolutely convinced that she will not die without treatment. I think that’s different.
We of course don’t know for sure how deluded she actually is.
What do you mean? We did that right here in this country for years.
If you want to believe in Dagon rather than modern medical science, thats up to you but if Dagon said “you have been cured so don’t bother with teh ysterectomy” and you believed that despite all evidence to teh contrary, then…
Again, the problem is that they AREN’T in the best position. They’re mentally ill.
Do you have a point? Yes, it’s not an easy determination to make.
I know it’s hard to deal with gray areas; all those tough determinations and fine details that need to be considered. But that shouldn’t stop us from doing what is right.
I’ve handled dozens of involuntary commitments, including a couple forced medical care for incompetents, and you’re absolutely right, they’re not fun at all. It’s depressing. Nobody, not the lawyers, not the doctors, not the magistrates, not the patients. Nobody likes it. It should always be the last resort.
But if the choice is between letting an incompetent person die and getting them treatment that they don’t, because of their mental illness, want, I think it’s an easy call.
We agree. I have no problem with a high bar.
Again, we agree. You’ve done these hearings, and merely being mentally ill isn’t enough (at least in my jurisdictions). You know the due process requirements. And, I’m guessing, you know that sometimes it is necessary.
And again, we agree. It would be wonderful if these kinds of things were never necessary, but they are. And the fact that there are grey areas, tough decisions, and bad circumstances shouldn’t stop us from making sure incompetent people get the medical treatment they need.
This is my dilemma: On one hand, I totally believe that we should have control over our own bodies and once you start deciding you know what’s best for other people, you are headed down a very slippery slope.
On the other hand, if someone was convinced they had an alien in their stomach and pulled out a butcher knife to cut it out, would it be ethical to let them? Could it possibly be the right thing to do to just shrug your shoulders and say “Well, it’s their right to think they have an alien in their stomach, and if they want it out more than they want to live, who am I to say?” Surely that can’t be right, but I can’t find the ethical difference in the two situations except for in the degree of insanity.
And then there is the case of clearly temporary incapacitation. If a drunk is in a car accident (say as a passenger, to remove any weird emotional charge here) and keeps pushing the EMTs away because he is so disoriented and in pain that he doesn’t understand what is going on, should they walk away and let him bleed out on the sidewalk? Clearly not, but again, the only ethical difference I can see is the temporary nature of the insanity.
So I guess I have to conclude that you just can’t draw a bright line here, and it’s because of things like this that we have to have judges, not just laws. But when it’s murky, and there isn’t anyone else’s life at stake, I think we ought to err on the side of protecting the freedom of choice.
Just for the record, if I’m ever so crazy that I’m refusing straightforward essential medical treatment, just treat me anyway and I’ll thank you if and when I recover.
Believing that God has cured you is not a mental illness. What mental illness does this woman have? We can’t allege that she’s not allowed to make the choice because she’s mentally ill without first establishing that she’s mentally ill.
Having a delusion is not the same thing as having a disorder. Everyone has their pet delusions. And some of those delusions are harmful. The standard must be higher than this.
I know several people who believe they are healed by the power of God. The way they specify it, they are spiritually healed but are waiting on the physical manifestation. They are told to continually tell everyone they are healed even when they themselves don’t believe it, because lack of belief means it won’t happen, so you can’t admit to it.
If she has a mental illness, we can allege that she, while sane, would not make this choice. But if she does not, we cannot.
I think Qadgop has outlined key issues and the dilemma posed by such cases very well. And I agree that adults should in all but extreme cases of mental impairment/psychosis be able to make decisions about their care, even if the result is likely to be death from a curable condition. Much as I personally find it foolish for a person to disdain a curative procedure on the basis of a religious conviction that God has taken care of things (why is it that God isn’t presumed to be working through the docs?), if one is putting self-destructive religious fanaticism under the heading of “mental incompetence”, then I have a problem with that (it’s not clear from what I’ve read about this particular case).
What’s different is when parents choose to forego lifesaving care for their kids for religious or various woo-based reasons. You don’t get to inflict your beliefs on minor children. It gets trickier when the child is, for example, a teenager who shares beliefs with his parents and wants to avoid standard therapy (with a high chance of long-term remission or cure) for lymphoma. Should a 17-year-old be considered adult enough to make this choice? How about a 13-year-old (I agree with the court order in the last-named example). But what if the treatment for an aggressive cancer is radical, highly painful/disfiguring and the odds of survival are low even with mainstream care?
By the way, survival in stage I cervical cancer (while depending on the degree of invasion) is at least on the order of 80-90% over a five-year period if properly treated. Once it’s metastasized, 5-year survival drops to under 20%.
Yes, that’s enough. If she said, “I understand that without this surgery I will die, and I don’t want this surgery,” it would be a much clearer case not to treat her. Because she brought in the delusion that God cured her already (when the doctors can still see the cancer), *she *created a sticky mess. A person with delusions is not mentally competent.
I suspect she figured this out (or someone told her this) and that’s why the second mental health evaluation found her maybe competent. She changed her tune, saying that she knows she’s still got cancer, and most people with this cancer will die without medical treatment, but she’s still hanging her case on the hope that God WILL cure her. This isn’t such a clear cut delusion, so now it’s more complicated than ever. Now we’re deep into the “is religion delusional”? debate, one on which mental health professionals have become tapdancers with more skill than Fred Astaire.
Really, people, if you don’t want treatment, leave God out of it. Just repeat back all the bad things the doctor told you might happen, tell him you accept those risks, and then you can refuse treatment without all this nonsense. (Unless there are children or fetuses involved; then it gets ugly.)
Yes, it is (was, at the time of the first hearing). Unless, of course, she’s been cured, then it would just be a fact. But she hasn’t. Therefore, the persistent idea that she’s been cured - whatever the mechanism - is a delusion. A delusion is a persistent idea not shared by one’s culture or religion. Now that she’s changed her story, of course, it’s hard to call it a delusion, because many religious people share the belief that God can cure them, and a delusion, by definition, is a belief not shared by one’s culture or religion.
If she claimed she cured herself with chamomile tea, but the cancer was still there, it would be just as delusional. Religion needn’t enter into it.
We’re taught that Advance Directives and DNR orders trump Medical Power of Attorney. That is, the PoA can allow or disallow anything as long as it does not conflict with the AD or DNR. Is this not correct? (Or is this one of those School vs. Real World issues?)