The NY Times asks a medical ethicist on the issue:
In general, patients may decline medical treatment if they are informed of the consequences of doing so and capable of making such a decision.“There are special considerations in emergency medicine because of the need to make rapid assessments,” Ms. Berlinger said. “You could have an evident life-threatening injury “” someone bleeding out of a carotid artery “” or the potential for a life-threatening injury that you can’t see, such as a stroke or spinal-cord injury. It is not always clear what is the patient’s capacity to make decisions, especially if the doctor suspects a head injury.”
A jury or judge evaluating the case, Ms. Berlinger said, might have to answer these questions about the procedure: “Was it medically necessary? Was the patient capable of understanding what was going on and making a decision about it and understanding the consequences of refusal?”
The area of contention lies in when exactly is one “capable of making an informed decision”. To some, it may simply be an ability to coherently answer questions. However, the answer is not so clear-cut in cases of head trauma. There is some subjectivity in the issue, which is why this lawsuit exists in the first place.
Personally, I think the case is frivolous. But I understand that it is impossible for non-medical personnel to be aware of the nuances of a head trauma workup, hence the outrage. Which is why having physicians communicate to the public why we do the things we do is important. You can read perspectives from both sides here.
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{ 2 comments }
“Which is why having physicians communicate to the public why we do the things we do is important. . .”
Unfortunately Kevin, some of the posts in the thread that appear to be by doctors communicate an assumption of arrogance and absolute authority over all who enter their realm rather than professional respect and appreciation for the trust that people put in us. They are of course the minority but some readers are going to take the name calling and flat dismissal of contrary opinions as indicative of the norm of the profession. Every family has some who are best kept in the back room when company comes.
I generally agree with Kevin (which is why there’s a link on my site to his). But not this time. There may be more facts to justify the physician behavior or the suit. But based on what was revealed in the NYT the case is not frivolous and the physicians were frankly wrong. Other or new facts may change my opinion.
You don’t have to be normal to be competent. You don’t even have to be well-informed to refuse.
John at http://aegis1.wordpress.com/
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