Understanding Treatment Over Objection in Non-Psychiatric Facilities: A Review of the Literature
Saturday, October 14, 2023
9:00 AM – 10:15 AM ET
Location: Dover C (Third Floor)
More is known about treatment over objection in psychiatric facilities because there is more legal accountability in the United States. But very little is understood about treatment over objection in non-psychiatric facilities involving non-psychiatric treatments. In the experience of the primary presenter who is an ethics consultant, these acts of care elicit considerable moral distress in clinicians and make stark the vulnerabilities of incapacitated patients who can nonetheless resist care verbally and/or physically. Isolated instances of practice guidelines authored by ethics consultants and health care professionals are valuable but a more comprehensive understanding of what is known about treatment over objection is needed.
The methodology, results and analysis of selected themes within a systematic literature review of treatment over objection in non-psychiatric acute care hospitals will be presented in this paper. After the inclusion and exclusion process, twenty-four articles were included: twenty one (87.5%) were case studies and three (12.5%) were descriptive studies focused on occurrence frequency. The articles were coded for recurring themes which were analyzed for conceptual relationships. Four core themes were elucidated: 1) Assessing decisional capacity 2) Recognizing patient resistance 3) Evaluating benefit / burden profile and 4) Coordinating decisional support. The complex relationship between assessing decisional capacity and recognizing patient resistance receives significant conceptual attention because intentional resistance can be ascribed in ways that confuse the status of being decisionally incapacitated. Furthermore, the process of evaluating the benefit-burden profile in light of added burdens like mechanical restraints were contingent on the available representatives to make deicsions.
Corinne Hamrick – Center for Biomedical Ethics and Society – Vanderbilt University