Background

Mental illness has always been a taboo topic avoided in social circles and ignored within family discussions given its difficulty to understand, treat, and manage. Whether it be the degrees to which an individual is afflicted with a particular set of symptoms, the fear that a disorder is hereditary, or the fact that these diseases cannot be cured but rather only managed instills fear, confusion, and hostility in both the patients and their loved ones. And unfortunately, the brain continues to be an un-mapped and untapped realm of curiosities that keeps modern science from being able to truly pinpoint how and where behavioral malfunctions occur. How then does one handle a scenario where a patient is at risk of hurting themselves but the course of treatment may be just as hurtful?

The Case of Mr. S

Having attempted on taking his life in his home, Mr. S is taken into an institution where he is to be managed until he is deemed fit to return to his domicile.However, instead of getting better and flourishing during his stay, he begins to further deteriorate and spiral into a deep depression. His behavior becomes increasingly erratic, he continues to show that he is suicidal and willing to act on said impulses, and he no longer finds meaning in life. Given that a conventional course of medications did not help his situation, Mr. S’s psychiatrist suggests electroconvulsive shock therapy to help with his worsening condition since there is evidence that such treatment has shown significant improvements in the lives of depressed patients.

Analysis

There are multiple issues with this scenario, the most pressing being the idea of quality of life the patient is to have post-treatment. Mr. S repeatedly states that he does not wish to live on and that the depression he lives with stems from guilt concerning his mother’s death, which will never leave him in peace. Given that the psychiatrist said himself that the treatment would most likely cause temporary memory loss, if the treatment is applied Mr. S will still have the memories of the issues that are causing him this grief. There is also the concern of the treatment itself being inhumane in nature. The patient’s quality of life is being violated if there are multiple measures being implemented to minimize the repercussions of this treatment. The muscle relaxants, the restraints, the anesthesia, and the oxygen administration all show how stressful this kind of procedure can be on the body.

Therefore, it begs the question: if Mr. S is conscious of his surroundings, able to explain why he feels the way he feels, and reject the same treatment that his son is likewise refusing on his behalf, wouldn’t it be a violation of autonomy to do otherwise?

In my opinion, it absolutely would be. In order to force treatment on to a person, you must be able to prove beyond a reasonable doubt that they are a threat to themselves or society. The catch here is that the person in question must also be deemed unfit to make decisions for themselves. Such accounts would fit the criteria for a “Baker Act” to take place (that is, institutionalize an individual for up to 72 hours in order to administer drugs and treatment without their consent). However, here we have a patient that is capable of expressing themselves in a logical fashion, that is aware of what is happening around him and still refuses treatment. A line must be drawn on where a person’s autonomy over their own life and the state of their life is. Especially when the advocate for a person such as Mr. S is not entirely contradicting the wishes of the patient. Successful treatment requires the cooperation between the patient and doctor. If the patient does not wish for the treatment, then in the moment they may get better but the long term results will reverse everything and perhaps even make the situation worse. From the understanding of preserving one’s autonomy over their own life, Mr.S should not be treated with a procedure that may not only hurt him but also not work and cause further harm, as well as removing his capacity to end his suffering in the manner he consciously wishes it.

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1)  http://academicdepartments.musc.edu/psychiatry/research/bsl/ect.htm