ABC news is reporting about an elderly, mentally ill patient who is on a hunger strike, psychotically believing he won’t die and it will bring him closer to God. ACT Health, supported by the ACT public advocate which is his leagal guardian, are seeking permission from the supreme court to not force-feed him, and allow him to starve to death.
On the one hand, doctors are there to ‘do no harm’ and force feeding him will harm him and be ‘inhumane’. He has declared his wishes and the doctors want permission to abide by them.
On the other hand, allowing someone to starve to death seems inhumane also. This case has parallels to the recent case of a quadriplegic man in WA beign given court permission to starve to death, except that this man cannot legally give consent. He may have ‘clearly expressed his wishes’, but he is in fact not able to decide for himself.
UPDATED: Chief Justice Terence Higgins has ruled that the hospital must continue to force feed him. In a quote from the paper CT but which I can’t find online, he said the patient must be treated as though he “lacked consciousness or was a helpless infant” due to his inability to give informed consent.
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astrojax said :
It does, but only if you manually remove the final . character
Riotact’s link recognition has limits, and can’t tell jt.html from jt.html.
(Don’t attribute to conspiracy what can be explained by legitimate technical difficulties)
Proper link: http://www.courts.act.gov.au/supreme/judgments/jt.htm
something’s awry – the link to justice higgins’ judgement does not work…
Quokka: I think Higgins does address that – re-read paragraphs 45 through 48 in particular. It is clear that in the case of a patient unable to give consent, lack of parent or guardian consent does not necessarily make treatment illegal.
moneypenny2612 said :
Interesting reading. Chief Justice Higgins has ruled that not treating this man would be unlawful. However, he has not directly addressed the issue that providing treatment against the wishes of the guardian would also be unlawful (except in situations covered the common law, i.e, emergency situations where treatment can be provided without consent – presumably not every day of this man’s life would consitute an emergency situation!). This would seem to leave the staff treating him in a lose-lose situation where both treating him or not treating him are unlawful. Hopefully his guardian will decide to agree to treatment and make things a little easier, since it doesn’t seem that withdrawing treatment is a viable option.
Thanks moneypenny, indeed an interesting read. It certainly did canvass a broad range of decisions, and the reasons given for agreeing or disagreeing, and relevance to this case were worth a read too.
Sadly, I suspect this is a long way from the last we’ll hear of this particular case. Having worked in disability support, I can empathise with those in the situation of having to provide uninvited care to someone who cannot be reasoned with in any rational way regarding that care. The day to day ramifications would be immensely stressful to say the least. And I suspect the peg will become the physical focus of his efforts to remain unfed, with attempts to remove the device a real possibility.
At the same time, having lost my wife to cancer, and observed the benefit of ever increasing levels of pain relief in achieving a dignified death, I can empathise with those promoting this course of action.
The critical issue for me continues to be INFORMED consent, choosing a course of action from a position of complete understanding of the consequences of that course of action.
I think the most concerning thing here is that Higgins made a seemingly sensible decision
moneypenny2612 said :
after reading it – i think Justice Higgins made the right decision and yes it is scary that the professionals thought it was ok to abide by the death wish of a mentally ill man. well done higgins
For those interested, you can read Chief Justice Higgins’s full judgment at: http://www.courts.act.gov.au/supreme/judgments/jt.htm.
It’s a worthwhile read as the judge canvasses court decisions made in other states and other countries, which arose in a wide range of circumstances. Obviously it is a very difficult decision for both clinicians and the law.
Personally I find it scary that in this case the shrinks and the hospital ethics committee thought is was in-principle OK to abide by the death wish of an insane man.
It’s worth bearing in mind that feeding this man in itself would not seem to be without serious risk. He is reported to weigh 41kg and to have not eaten for 2 weeks. Feeding in his current state would be likely to have a high risk of inducing refeeding syndrome (a dangerous metabolic condition that can occur when nutrition is provided to people who are severely malnourished – as an aside this was first described in WWII POW’s who died after they were refed following their rescue from prison camps). In elderly patients refeeding syndrome can have a mortality as high as 50%
http://content.karger.com/ProdukteDB/produkte.asp?doi=10.1159/000218162
Given that this man (and also his legal guardian) has not consented to treatment, continuing to treat him in the absence of a court order would expose the staff treating him to charges of at least assault, and possibly manslaughter if he were to die as a result of his treatment. I can see why they wanted a court ruling on how to proceed!
Don’t they go against people’s wishes suffering anorexia all the time? They are thinking food is the devil. Just a thought..
Astro, I’m only being mildly facetious on this matter. I really do feel that we are passing judgement about mental state based on a divergence of views. The court seems to believe that choosing to starve yourself to death is evidence of madness. I would argue that simply having a view that is so wildly different from the common experience doesn’t really mean you’re mad.
but, ck, as the recent case in wa showed, it is precisely this patient’s lack of [mental] capacity to determine his best interests (given we live in a society that doesn’t condone murder) that take this course due to the patient being unable to ‘make decisions about his own life’… if he were of sound mind, perhaps he may have some sympathy (he’d have mine) to choose to terminate his own life, but i think we must act as a community to ensure someone with no such mental capacity isn’t assisted to die when we have no way to determine what his ‘sound mind decision’ may have been. there is no room here for speculation.
If they feel it’s OK to kill him, they should do so humanely, not by starvation.
Have to say I’m pretty much with Astro on this, critical point is capacity. The debate about euthanasia doesn’t even begin until you’ve established “of sound mind”. And surely a mild anaesthetic to assist in the feeding process is a far more reasonable approach than petitioning the court to allow a person to follow a course of action that they do not understand will lead to their death.
I disagree Astro. It is my view that the court has plainly made a judgement of convenience believing that it has the authority to decide that this man, regardless of his mental state, does not have the right to make decisions about his own life.
Continuing with the current treatment is tough on the medical staff – CT said they have to strap him down incredibly tightly to stop him pulling out all his tubes etc. Continuing with this seems bad, but ceasing to feed is also bad. Hence the lack of comments I think – there just isn’t a good option to advocate for.
i dunno, i thought this would be a divisive issue with a number of people genuinely, or for their own stirring reasons, posting in strong support of euthanising this chap – we get [or got] a hundred + posts on other topics where ‘justice’ is at issue and here it is writ large but no-one has an opinion…
i’m glad the system has upheld common sense, for once.
astrojax said :
I think its a sad situation and have nothing else to add than what I already have. What are you expecting people to say astrojax ?
“if he wants”, doves, is the critical point here.
‘wanting’, in its strictest sense, implies a capacity to do this is a sane and rational manner. a crazy person might ‘want’ to put their hand in a fire, but would you ‘want’ to let them? this person does not, from the reports (of course, i am not the consulting psychiatrist), have the capacity to ‘want’ such serious consequences that we should simply allow them to have them. as i mentioned above, i believe the community here has a strong duty of care.
so re your ‘apart from the mental illness’ – well, the ‘mental illness’ is quite enough for loud alarm bells to ring in this case and tell us much about any stated ‘desires’ he may have expressed.
i’m surprised this thread is so bare of comment – i wonder if this is the way of the world post-jb?
I believe he has a right to die if he wants, apart from mental illness, what else is he suffering from, if its cancer, I can understand, as it is very cruel and having to watch someone suffer is just terrible, the pain he has to endure.