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Discussion

Forced meds?

So...if a patient who is an adult but has the mental capacity of a third grader refuses her Insulin and po antibiotics...and the doctor says just Go in there and give her the insulin without saying anything to her...would You do it?

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    If it is the considered opinion of the attending physician that the individual lacks the mental capacity to make an informed decision to refuse the medication, then s/he can overrule the individual's wishes and the medication can be given over the individual's objections. Personally, I would insist that the physician document in the record her/his opinion about the individual's capacity and that that is the reason why the medication is being given against the client' wishes before I gave the medication.

    Does the individual have a family member or significant other who is next of kin? In situations of diminished capacity, providers usually turn to a family member to make decisions for the individual.

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    • Experts

    I'm still not doing it without appropriate legal documentation. If this is a known issue or concern for the patient, there should be surrogacy or guardianship documents for decision-making. While there are times that the primary care physician can designate diminished mental capacity, that doesn't mean they necessarily should especially if something is known ahead of time regarding the persons condition.

    To me, this would be less about doing something to/for the patient and actually covering my own behind because I worked really hard for my license and my career to have it be derailed by following a physician request in a situation like this without support from hospital administration or prior filed legal paperwork.

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    States have different laws in these situations. There had better be some legal paperwork specific to your state filed in the chart, or I would not participate in this.

    I don't think having just a statement from the MD is going to cut it.

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    Right of refusal can get complicated with intellectual disabilities. Even in situations when another individual (legal guardian or in the appropriate circumstances, a provider) has directed that the medication/ intervention etc. be administered/ implemented if the individual refuses.

    Approaching things from a different angle sometimes works. Identifying why the individual is refusing can be helpful. Providing education in a manner that the patient understands is also important - I wouldn't use the same verbiage for an adult with "normal" intellectual abilities as I would for an adult with the cognitive ability of a 3rd grader. Also, finding out if the individual has a specific routine for taking meds can be helpful. Engaging the individual in the process sometimes works too (site selection etc). Or diversionary techniques (take a deep breath... and blow out while the insulin is being administered etc).

    Where I'm going with all of this is that even though it can be time consuming, if an intervention is medically necessary sometimes (not always!) refusals (and power struggles) can be side stepped by implementing different approaches.

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    No. I've done all that. She grunts, yells NO and covers her head. So you think it's ok to try and pull her covers off and just stick her? I don't and when I go back in, if she's still there I'm asking to not take care of her. I don't want to be involved in any of this...

    Tell me how I would get her to take PO meds? Make her? Exactly how??

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    Apparently they've made her parents in charge of her care. But they got this over the phone....they don't come in.

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    Making decisions still means I would have to forcibly inject her. Sorry I'm not doing that. Her parents aren't even involved with her.

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    No. I've done all that. She grunts, yells NO and covers her head. So you think it's ok to try and pull her covers off and just stick her? I don't and when I go back in, if she's still there I'm asking to not take care of her. I don't want to be involved in any of this...

    Tell me how I would get her to take PO meds? Make her? Exactly how??

    Sounds like a tough situation. What suggestions/ input does your supervisor/ manager offer? Is there an ethics committee that you could collaborate with?

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    • Author

    I've only contacted her OB who says I need to just draw up the insulin, take it in and jab her without speaking. I'm not doing that.

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    I'm going to request not to be assigned to her anymore...

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    Is she pregnant? If she's that developmentally delayed she may have lacked the ability to consent to sex and that might explain some of her refusal to be reasoned with as far as meds?

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    • Experts
    I've only contacted her OB who says I need to just draw up the insulin, take it in and jab her without speaking. I'm not doing that.

    You said in your original post that she has the mental capacity of a "third grader." If a child in third grade didn't want to take necessary medication, would you just skip the medication? We're talking insulin here, not a cough drop or something else entirely optional. I don't know about you, but, when I was a young child, I didn't get a choice about whether or not I wanted to take medication.

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