Friday, February 22, 2013

Informed consent and forced treatment

One day one of professors of ethics told me, “Ethics is not a simple matter.”
He continued, “For example, it is not an ethics that to be kind to elder person. In real world, there are a lot of dilemmas. You should help an elder person, but you have to hurry up to go to other place. It is the ethical situation.”
I remember this thought well in my university class.

In medical situation, ethics is of course important. We must get informed consent from the patient before treatment performs.

However, the term “informed consent” is complicated one.

In legal context, informed consent means the human right to refuse any treatment according to one’s free will. The choice is patients’. Therefore, the responsibility of decided treatment is shared by both the therapist and the patient.
Any treatment is not certain. Some patients will get recovered. Others will die. If physician was arrested every time the patient died, nobody would be a physician.
So, the concept of informed consent has changed from human right to self-responsibility.

Self-responsibility is dangerous concept. Especially, in mental health issue, we are to be prudent to use this thought. IF the patient was suffering from mental illness, it would be possible that the desire told by the patients is not true. Self-responsibility and informed consent may kill the patient.

When is forced treatment allowed, overcoming informed consent? Each country establishes their legislations. United Nation set a principle of mental health care, called “The protection of person with mental illness and the improvement of mental health care.”

General Assembly

Japan has ratified this treaty. However, human right protection for the patients with mental illnesses is still weak. Ethical committees are not working in most mental hospitals.
On the other hand, there is the other side in forced treatment. If treatment was delayed, the patient would harm self or others in some cases. We practitioners have duty to protect both human right and life of the patients. Every day we face a dilemma.

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