Ethical Car Crash

Happy New Year!

I’m sad to see the end of 2011, it was a good year. Beginning for us in Melbourne as we finished our 12 months of living the Australian Dream. Leaving the UK with one child, vitamin D deficiency and needing a break from the rat-race; returning with two children, arguably fitter and healthier but nonetheless eager to return to the NHS pressures and desperate for the stoic, dry wit of British humour.

So the New Year begins with my realisation that psychiatry is akin to a car crash, terrifying but at the same time morbidly fascinating.  Imagine this scenario: you are a middle aged vulnerable woman, scared for your safety and go to the police. When here you are placed in handcuffs and driven to a psychiatric hospital. Here you are questionned by 2 doctors, discussing intimidate details of your childhood and all relationships throughout your life, as the conversation comes to an end it becomes clear the plan is to admit you to the ward. In defending your case you are detained under the mental health act (the implications of this substantial for future mortgages, visa applications for travel etc). Once on the ward you are given medications you know nothing about and sometimes against your will. 

I have no trouble in understanding these patient’s are unwell, as such they are a danger to themselves and potentially others and a simple treatment can give them back their clarity and dignity.  There probably is little option to detaining and treating them, and in all fairness the rigour through which these detention orders are scrutinised would be hard to enforce without very good reason.  But, and there was always going to be a but, this flies in the face of all the ethical pronciples I was ever taught, and does not sit easy on my moral conscience.  I’ve been taught in the era of patient-centredness, examined on the ability to gain informed consent before any procedure, presciption or examination, and wholeheartedly encouraged to enquire into the patient’s ideas, concerns and expectations.

So far removed is this from the paternalistic approach I have seen in psychiatry that I can’t help but question it: How much autonomy do those we treat paternalistically really have and when (if ever) is it deemed appropriate to step in and take charge of someone else’s life or body?

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