The RangelMD has a pretty upsetting post entitled, “Medical Ethics: You can’t force a patient to stay alive.” I realize, this post may get more complicated than I mean it to because it raises, in addition to medical malpractice, “right-to-die” and euthanasia issues, which I would like to avoid.

Putting those things to the side, it shouldn’t be arguable that a patient can refuse treatment without being sedated and having it forced into him. There are patients who have lost their authority to make their own medical decisions, but there is an understood court procedure required for that to happen.

But, in this case, the doctors removed the patients authority to make his own decisions without any legal right to do so.

This was witnessed by the family, the nursing staff, and myself and was well documented. But the pulmonologists felt that the patient may not be capable of making his own decisions because the carbon dioxide level in his blood was rising as a result of his ventilatory failure. However, it was obvious that he remained clear headed and able to determine his own fate.

Then one of the lung specialists ordered that the patient be sedated and placed back on the ventilator. Hold on a sec! Isn’t that assault? Yes it is. But the specialists felt that from a liability standpoint, they could not be 100% sure that the patient is fully competent since he could not speak and he had a relatively high carbon dioxide blood level. They felt that this uncertainty could be brought up in court and used against them should the case ever go to trial.

Wait a minute! The family witnessed the patient communicating with the staff and they agree that he is competent and free to make his own decisions. All of this has been witnessed and properly documented. And nobody is talking about a lawsuit. As far as I know there are no issues of potential malpractice in this case. But the specialists felt that they should err on the side of keeping the patient alive since some uncertainty remains.

While I suppose the wisdom of all this is debatable for some readers, I don’t think anything really positive can be said about sedating and forcing treatment on a patien against his will. Basically, our medmal environment makes it impossible to trust patients. If they later regret what they were allowed to decide (or their family regrets it), they have the option of suing.