naath | (no subject)

(no subject)

A 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.

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Oh, gosh, yes, the bike lights thing is So Annoying! 'Did you know your lights are on' 'Yes, it's a dynamo'. It's the most Tedious Conversation Ever. But then every time I suffer it, there is someone else out there going 'Oh, gosh, I hadn't noticed! Thank you for saving me the problem of a flat battery!'...

In general i agree about the forced medication; there are a few exceptions (such as people who are a danger to themselves and others, but think they don't need their meds), but they are rare & should be evaluated on a case-by-case basis.

Forcible medication... Obviously I am unable to consent to being forcibly medicated at the time, however I could conceivably consent in advance. If I think about circumstances, and assume generously that people will be doing their best to act in my best interests - and that their best is a good best:

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

lysystratae's case-by-case thing, with very careful regulation from the outside, looking at feedback from people who have (or haven't) previously been forcibly medicated, erring on the side of not medicating. But I still twitch. The thought of intervening on behalf of someone's True Self, knowable from the outside but not from the inside, is so abusable...

provides for detaining and forcibly medicating people

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? )

I think I'd want to know an awful lot more about the legal, practical, moral and ethical issues surrounding the Mental Health Act 1983 (under which people can be "sectioned") before I'd want to say that it is always a bad thing. Clearly it can be used in a bad way - but is it always? I simply don't know. Yes, it *does* make me a bit uncomfortable at times, but I think it may sometimes be necessary, and indeed sometimes necessary *before* people have prevented actual crimes.

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.

Suppose an infant is ill. Is it better to forcibly medicate them or to imprison them until they either die or get better?

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

Looking at the more trivial problem, this is my advice that is so wonderful and amazing that obviously you want to follow it:

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

I have no idea about the ethics, but yes, it irritates me too to be told my dynamo bike lights are on.

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