“Can They Hold Me Prisoner?” When Right to Freedom of Movement, Patient Safety Concerns, and the Ethicist’s Obligations Collide.
Friday, October 13, 2023
5:00 PM – 6:15 PM ET
Location: Galena (Fourth Floor)
False imprisonment occurs when one is restrained by another without legal authority. State mental health laws govern when and if providers can involuntarily detain/hospitalize a patient for psychiatric treatment, usually requiring a court order. Most states/jurisdictions do not grant statutory legal authority to involuntarily detain/hospitalize patients without psychiatric illnesses. Nevertheless, if a provider feels medical treatment is necessary and a patient seemingly disagrees/requests to leave, the provider will assess the patient’s capacity to leave/refuse treatment. If the patient is determined to lack the capacity to refuse/decide to leave, often providers will attempt to prevent the patient from leaving, irrespective of if the impaired decision-making stems from a mental or physical illness. The literature on this topic reflects this thinking; articles routinely take for granted that it’s permissible to involuntarily detain incapacitated individuals in the hospital for their own good.
The absence of statutes outlining due process (procedural requirements, appeal rights, oversight) for “medical” holds has led to at best, hospital policies filling the void and at worst, no guidance at all. Existing policies may not adequately balance patients’ liberty rights and risks from involuntary detention against providers’ judgments of risks from leaving, nor provide adequate recourse for inappropriate detainments. Under these conditions, ethicists may grapple with competing obligations to their employer and the patient. This presentation will explore these issues through the experiences of one hospital’s clinical ethics consultation service. We will discuss key insights learned about how to navigate these cases and conclude by discussing recommendations for hospital policies.