Who should have the final say in patients’ involuntary treatment?: Viewpoint

Mariah Taylor (Email) – Becker’s Clinical Leadership

Many states require a court order to determine involuntary treatment, but independent committees could be a better way of meeting patients’ needs, Sandeep Jauhar, MD, PhD, a cardiologist in New York City-based Northwell Health wrote in an opinion piece published in The New York Times May 13.

Dr. Jauhar wrote that in most cases, the law ought to keep care decisions in hospitals and the hands of physicians and medical specialists.

Judicial review of involuntary treatment, or “treatment over objection”, has been in place for more than four decades. In the 1980s, the Massachusetts Supreme Judicial Court determined a judge could override medical judgments in favoring involuntary psychiatric treatment. It was established to protect patients’ rights and avoid “the sort of paternalistic abuses that have characterized too much of medical history” — with some exceptions for life-threatening emergencies and when there is pressing societal interest.

Judges are not experienced in properly evaluating psychological states, assessing decision-making capacity or determining whether a proposed treatment’s benefits outweigh its risks, Dr. Jauhar said. Some estimates say that 95% of requests for treatment over objection are approved by judges who haven’t met the patient.

“Physicians today are trained in shared decision-making,” Dr Jauhar wrote. “Safeguards are now in place to prevent such maltreatment, including multidisciplinary teams in which nurses, social workers and bioethicists have a voice.”

A better system for safeguarding patients could be a hospital committee of physicians, ethicists and other relevant experts who would be independent of the hospital and not involved in the care of the patient. They could hold hearings on-site with published documents to outline the reasoning for decisions and periodic audits by regulatory bodies to ensure the deliberations meet medical and ethical standards. Such a committee could expedite decisions and minimize treatment delays. In cases where the committee cannot agree on the best course of action, they could appeal to a judge, Dr. Jauhar suggests.