(no subject)
Nov. 2nd, 2012 09:48 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
naathA general trend in nuisances...
Whilst it is very nice to be helpful, to offer practical assistance or information or opinion that might assist me in making decisions (there are many ways to be helpful) it is often the case that the help offered may not actually be helpful, for a variety of reasons. Naturally this help has been offered out of kindness and generosity and should be politely refused, not rudely rejected. This is not the nuisance.
The nuisance is when the help-offerer goes on to insist that you accept their help, follow their advice, etc. even after I have politely declined and offered an explanation.
This is a nuisance (and worse than a nuisance) at a wide range of levels - from the small-time barely-a-flicker-of-irritation right up to serious assaults. Naturally the more serious the violation the more annoyed I am about it; but I am also generally-annoyed about the prevelance of this idea that my help/advice/etc is SO WONDERFUL AND AMAZING that OBVIOUSLY you want to follow it.
At the most trivial end - my bike lights have no battery, they do not need to be turned off, I deliberately leave them on at all times because I'm a lazy wottsit. So, naturally my life includes a large number of people telling me I have done so; or even turning them off while I'm not there. I strive to remember that these people are generous helpful people who I can't reasonably expect to know anything about how my lights work.
At the most serious end - the law in this country provides for detaining and forcibly medicating people if the relevant someone decides that that's a good idea. Now, I am absolutely all for providing absolutely everyone with all the medical treatments that they want; and I am on-balance in favour of detaining people who have committed crimes in part in order to protect others from the possibility that they will commit more crimes; I'm certainly in favor of offering people who have committed crimes the option of receiving medical treatment whilst detained; I'm just not in favour of people being forcibly medicated against their will.
Whilst it is very nice to be helpful, to offer practical assistance or information or opinion that might assist me in making decisions (there are many ways to be helpful) it is often the case that the help offered may not actually be helpful, for a variety of reasons. Naturally this help has been offered out of kindness and generosity and should be politely refused, not rudely rejected. This is not the nuisance.
The nuisance is when the help-offerer goes on to insist that you accept their help, follow their advice, etc. even after I have politely declined and offered an explanation.
This is a nuisance (and worse than a nuisance) at a wide range of levels - from the small-time barely-a-flicker-of-irritation right up to serious assaults. Naturally the more serious the violation the more annoyed I am about it; but I am also generally-annoyed about the prevelance of this idea that my help/advice/etc is SO WONDERFUL AND AMAZING that OBVIOUSLY you want to follow it.
At the most trivial end - my bike lights have no battery, they do not need to be turned off, I deliberately leave them on at all times because I'm a lazy wottsit. So, naturally my life includes a large number of people telling me I have done so; or even turning them off while I'm not there. I strive to remember that these people are generous helpful people who I can't reasonably expect to know anything about how my lights work.
At the most serious end - the law in this country provides for detaining and forcibly medicating people if the relevant someone decides that that's a good idea. Now, I am absolutely all for providing absolutely everyone with all the medical treatments that they want; and I am on-balance in favour of detaining people who have committed crimes in part in order to protect others from the possibility that they will commit more crimes; I'm certainly in favor of offering people who have committed crimes the option of receiving medical treatment whilst detained; I'm just not in favour of people being forcibly medicated against their will.
(no subject)
Date: 2012-11-02 03:09 pm (UTC)(no subject)
Date: 2012-11-02 03:17 pm (UTC)(no subject)
Date: 2012-11-03 09:20 am (UTC)(no subject)
Date: 2012-11-03 10:12 am (UTC)(no subject)
Date: 2012-11-02 03:28 pm (UTC)(no subject)
Date: 2012-11-02 03:35 pm (UTC)If I'm a danger to others then I should be locked up for their protection; but I'm not convinced that gives them the right to drug me except in immediate defense of their person.
(no subject)
Date: 2012-11-02 03:50 pm (UTC)[FTAOD I mostly agree with you and am playing devil's advocate, because I don't think my position is very consistent]
(no subject)
Date: 2012-11-02 03:55 pm (UTC)I think screwing about inside someone's head is a bigger violation than locking them up (when done non-consensually; obviously done consensually it's not a violation at all).
(no subject)
Date: 2012-11-02 04:04 pm (UTC)But on the other hand, I think this is a very difficult question for lots of reasons. At one end of the spectrum, suppose that someone comes to you with their doctor and says "so long as I have this medicine I'm exactly who I want to be, exactly myself, but if I forget to take it I lose all my personality and go into an irresistible homicidal rage, if you see me like that, please, please force me to take the medicine even if I don't want to". I think most people would agree that was better than the alternative.
On the other hand, there's a long and sordid history of mental and physical illnesses, unusual life choices, uncooperative people, etc, etc being treated with drugs that are more about controlling them than actually helping them, and if you're at risk for being drugged into something you consider not-you, I think you're right to be horrified.
I think most people would agree with those two ends of the spectrum in theory. But I think people would disagree how common they are. One person might say "surely if a doctor recommends it and a court orders it, it must be for the best?" Another might say that inappropriate use of medication is so prevalent that even if there are theoretically justified situations they're vanishingly unlikely compared to everything else, so it's simpler to just say "never force-medicate ever, because it's almost certainly a gross and unhelpful invasion of bodily autonomy".
I suspect the truth is somewhere between those extremes, as in, for some people it indisputably helps and later on they would uncoercedly agree, and for other people, it's synonymous with having their autonomy taken away and being locked up in a mental hospital until they can pretend to be "normal", but I don't know how comparatively common they are.
(no subject)
Date: 2012-11-02 04:14 pm (UTC)I don't have any numbers on this sort of thing at present; I expect it's a difficult sort of thing to count at the time.
(no subject)
Date: 2012-11-02 04:15 pm (UTC)(no subject)
Date: 2012-11-02 04:35 pm (UTC)(no subject)
Date: 2012-11-02 10:05 pm (UTC)Full disclosure, I have one friend who is schizophrenic, and a danger to himself when not medicated in that he tends to wander in front of moving vehicles (and trains, that was a fun one), and say nonsensical things to strangers that result in him getting beaten by jerks. I know another boy (paranoid schizophrenia in his case) who seemed to be harmless, just took his gaming a bit too seriously... until one Christmas, after spending a couple hours at our house helping to decorate the tree (and weirding out my mother in law talking about elves and dragons like they were real), he left 'to run an errand'. That errand was to drive over to the house of a woman he knew, and kill the dragon disguised as her father. With a sword. He then drove back to our house to spend the night with my sister and some other friends, with no sign anything had happened. We found out what his 'errand' was 3 days later when he was on the news being picked up by the cops for the murder. His mother said he'd been refusing his medication for months.
So yes, I'm biased.
(no subject)
Date: 2012-11-03 10:11 am (UTC)(no subject)
Date: 2012-11-03 10:14 am (UTC)But is it in the interest OF THE CRIMINAL to be medicated rather than incarcerated? That is a question I think only the individual can answer.
(no subject)
Date: 2012-11-02 04:16 pm (UTC)1) If I start acting seriously out of character, due to a new organic cause, for example a brain tumour. This, I think, is the prime case for forcible medication, as I wouldn't say my reactions are me.
2) If I start acting "seriously out of character", due to a psychological cause, for example a traumatic incident. Arguably my reactions are still very much me. That said, it could be argued the other way.
3) If there is some ongoing oddness due to an ongoing cause that has been around for a long time, where some magic threshold has been crossed. This cause is a part of me, so it would be hard to justify forcible medication. OTOH if I have been aware of this in advance, and I've previously said, "I'm in a degenerating state, if I degenerate too far, medicate me", then fair enough.
4) Diathesis-stress (http://en.wikipedia.org/wiki/Diathesis%E2%80%93stress_model) - some ongoing neurological oddity, which previously had been sitting there quietly, is brought to the fore by a traumatic incident. I have previously not known about this, and have not had the opportunity to build character traits to deal with this. It really isn't clear whether the lurking oddness is me - hence the worries in point 2.
When I look at this... I can see this translating into
(no subject)
Date: 2012-11-02 04:22 pm (UTC)I think giving consent in advance ought to be allowed - both in terms of "if I get to this point give me this drug" and in terms of "if I get to this point just let me die". Easier to set up if you've diagnosed someone as being in the early stages of a condition than if you first meet them in the later stages.
(no subject)
Date: 2012-11-02 08:54 pm (UTC)The whole problem of two states, in both of them I want to stay in the state I'm in, is a nasty one. I have no idea how to solve this, but I wonder how real world it is - have you ever encountered someone who's been in that situation (or are they all locked away in metal institutions which is why we've never met them)?
(no subject)
Date: 2012-11-02 04:30 pm (UTC)By medication, do you just mean drugs, or do you extend to other medical treatment as well?
(I.e. What's your take on non-consensual medical procedures? )
(no subject)
Date: 2012-11-02 04:40 pm (UTC)I don't include emergency life-saving procedures carried out on unconscious patients; since there is in that case no opportunity to discover whether they consent or not. (Although I would usually expect medics to check for things like bracelets or tattoos with important medical information).
(no subject)
Date: 2012-11-02 05:35 pm (UTC)(no subject)
Date: 2012-11-02 08:17 pm (UTC)Also I know about things like China forcing women to have abortions - which I think is VERY WRONG but I don't think people like that are making the error of supposing that they are "doing what you want, really"; I think they've decided that some other goal is more important than what the individual wants and/or are vile sadists.
(no subject)
Date: 2012-11-02 05:56 pm (UTC)(no subject)
Date: 2012-11-02 08:15 pm (UTC)Also because I think there really is a difference between someone standing there shouting "NO" at you; and someone who can't communicate at all. I don't believe that psychotic patients are utterly incapable of reasonable communication.
(no subject)
Date: 2012-11-02 05:00 pm (UTC)If, during a bout of insanity, I had an infection and needed antibiotics, and I refused them because I thought the doctors were trying to drug me... intuitively, forcibly giving me antibiotics seems less controversial to me than forcibly giving me psychoactive substances.
(no subject)
Date: 2012-11-02 05:57 pm (UTC)If you think it's only psychiatric treatment that they force on you, um, no. My life experience says otherwise.
(no subject)
Date: 2012-11-02 06:25 pm (UTC)From the way the discussion was going, I'd latched onto the issues specifically to do with forcible psychiatric treatment, but yes, that isn't the whole of it.
(no subject)
Date: 2012-11-05 02:06 pm (UTC)OK, now extend that to someone who is lucid, calm, rational and able to talk.
(no subject)
Date: 2012-11-05 02:12 pm (UTC)Did they have a fig-leaf justification of any sort, or was it completely "I'm the doctor and I know best"?
(no subject)
Date: 2012-11-05 05:52 pm (UTC)In A&E and Doctor orders you to have an excruciatingly painful test ASAP? Well, then that's what you get. What do you mean, you only consent if they numb it first? *That's* not an option!
Oh, it's not like there's no choice at all. You still get to choose between holding still or being held down.
(no subject)
Date: 2012-11-02 08:19 pm (UTC)The bacteria aren't that smart yet...
(no subject)
Date: 2012-11-02 05:43 pm (UTC)I haven't done much more than skim this for now:
http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/DH_4002034
but I note that it's the relevant *three* someones in most cases, according to this more layman's guide:
http://news.bbc.co.uk/1/hi/health/2204983.stm
There's certainly part of me that feels if I was seriously mentally ill and a danger to myself and others it would be far better to try and treat me, as much as possible with my consent, than simply to lock me up and throw away the key. I know not everyone feels that way, but how can you tell in advance which people are which? Surely (as medical professionals) you have to use your best judgement, including input from the close family or social workers who know the person best. And no, that won't always be right - just as it isn't always right when family are deciding the right treatment for a child who cannot consent either.
(no subject)
Date: 2012-11-02 08:11 pm (UTC)I'm pretty against locking people up because you think they might commit a crime (bearing in mind that actually planning crimes is the crime of conspiracy-to-commit-the-crime). I also am in no way convinced that "harm to self" is usefully defined in law - is it "harm" when I take part in extreme sports like rock climbing? when I cycle on the A14 without a helmet? when I drink gin until I pass out? These things are risks, they might actually be bad for me, yet I think I should have the right to do them.
Locking up and chucking the key is clearly a last resort; and efforts should be made to, eg, persuade people to accept treatment where useful treatment is available. But if they are standing there saying "I will not take this drug, you should lock me up" I think you have to go with that; if the patient is unable to usefully communicate their lack of consent then the case is less clear.
Requiring three someones reduces but does not eliminate the potential for abuse. Although I think "malicious abuse of system to remove inconvenient annoyance" is different to "was really honestly trying to help but failed to understand what I wanted".
Having been treated without my consent (it wasn't sought, although it would have been given) as a minor I find the comparison quite useless.
(no subject)
Date: 2012-11-02 08:30 pm (UTC)(no subject)
Date: 2012-11-03 11:22 am (UTC)Clearly, there's scope for the care givers to be wrong about what course of treatment is wrong for the child, or be wrong that what they don't like about the child constitutes an illness. Or indeed to be wrong about the child's capacity to give or withhold informed consent. But in at least some circumstances society is content that it's fine for the child to be treated.
While I personally feel society may be a bit too relaxed about that, I'm certainly not about to throw the baby out with the bathwater (er… to choose an unexpectedly appropriate metaphor) by saying infants should never be treated.
Now: is it possible for an adult to be so mentally disabled that their capacity to make rational healthcare decisions in their own best interests is disastrously impaired? Short answer: yes. I'm not talking about people behaving irrationally for other reasons, nor about minor aberrations, but in the starkest terms, if someone is in a condition which means both that they'll die without treatment and are in no fit state to accept and take the treatment, unless there's some living will or similar indication of what their views were when they were in a fit state, I say give them the treatment.
If you found someone unconscious and bleeding in the gutter, you'd call 999, the ambulance would take them to hospital and the hospital would treat them before they regained consciousness. That's completely routine and fine. Why does a different principle need apply if the person genuinely lacks the capacity to give informed consent for treatment in some other way?
And yes, as with the case of a child, I suspect we're a little too ready to forcibly medicate adults. History certainly shows that, for example, homosexuality, heresy and dissidence have been forcibly "treated" in the past, so it would be complacent to believe people in another century's time won't look back in horror at some of the things we're doing now.
But perhaps the media's a little too keen to cherry-pick the cases where things go wrong. I certainly hope the majority of cases are a little more comfortable and clear-cut and thus never get reported. /-8
(no subject)
Date: 2012-11-03 12:51 pm (UTC)I actually think the way we handle getting consent from children is vile as well - the child should be asked and listened to even if it turns out that they do have to be overridden. When I was 11 and had my appendix non-consensually removed I would have been perfectly capable of understanding "we are going to take your appendix out so it stops hurting you" but no one even thought to ASK.
(no subject)
Date: 2012-11-03 11:26 am (UTC)- Turn the light off anyway, because it's less hassle than explaining to people that you left it on deliberately.
- Defeat the light's off switch, so passers-by can't turn it off.
- Rig up a reed switch on your bike lock holder so the lights go out automatically when you secure it.
:-p(no subject)
Date: 2012-11-03 10:34 pm (UTC)