> financially benefits from that control
Yeah, this is a more fundamental problem with for-profit hospitals - money gets involved in treatment decisions.
“Alyssa signed the form, but Plumbo declined to answer CNN's questions on the record.” https://amp.cnn.com/cnn/2018/08/13/health/mayo-clinic-escape...
It's good that at least for now there is still choice in facilities in our country. This would have been a much different outcome otherwise.
I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
On one hand, it's bad to disregard patient autonomy and legitimate guardianship, especially in such an extreme way.
On the other hand, if I was a professional convinced that not doing so would be likely to cause the death of a patient, I can't tell you for sure that I wouldn't do the same thing. The Hippocratic Oath does not say "First, follow the law; Second, do no harm".
>I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
Well then they could have told the family that was their line of reasoning for not wanting the transfer. If they had a defensible reason they would have worked that angle before using the system to try to make an end run around the patient's/family's wishes.
Anecdote: I had whooping cough a few years ago, unbeknownst to me, during a national whooping cough epidemic, where the NHS had put out a bulletin telling doctors to look out for whooping cough.
During this time I had fits where I wouldn't be able to call an ambulance because of the shaking. I also could have potentially killed infants I came into contact with.
Both the NHS and private doctor ignored the possibility of me having the disease - my partner's mother, a registered nurse, even suggested I ask them to look for it - simply because they didn't think of it when they first arrived.
And of course both the private and NHS doctors arrived late, don't apologise, and insist I call them by their title rather than their name.
My general feeling of the medical industry in the UK is that it has more respect for formality than professionalism.
Mayo is not for-profit.
Also to the police, who refused to pursue the "abduction" once it was clear that the patient was being taken care of at another hospital.
They were told it was a medical emergency, and they had no information to contradict that. (Yes, obviously the parents said it wasn't, but the parents aren't trained medical professionals). Once they got conflicting information, they could back out of the matter—and did so.
It all points to public healthcare where there is governance at a political level and not profit level.
The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia.
Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
Outcomes might be better than if there was no intervention, but that doesn't necessarily imply that mental health services are effectively doing anything more than providing "protective custody".
It is incorrect to take my response outside of its intended context and attempt to attack it there.
Also, O’Conner vs. Donaldson was the key case that caused a significant shift in mental health treatment.
Blaming Reagan is intellectually lazy.
There are different forms of detention, and different forms of forced treatment.
These are described (for England) in the Mental Health Act.
This is what it means to be sectioned - you are detained under section of the mental health act.
The most common sections are:
Section 136: a police officer can detain you in a public place and take you to a place of safety to be assessed. This requires one police officer. It lasts a maximum of 24 hours (but it can be extended by 12 hours).
Section 2: this is a short 28 day hold for assessment and treatment. It requires 2 doctors and an AMHP. Traditionally AMHPs were social workers, but they don't have to be and there are increasing numbers of nurses becoming AMHPs.
Section 3: this is a six month hold for treatment. It requires 2 doctors and an AMHP.
Section 4 is another short term hold (72 hours) that can be used in emergencies if there's only 1 doctor available.
https://www.rethink.org/living-with-mental-illness/mental-he...
They changed the law in part because of the horrifying conditions under which people were living who had been committed.
Having slept in a tent for nearly 6 years, I would take that over de facto imprisonment in an asylum any day. I did spend 10 days in an asylum in my teens. This is not an uninformed opinion by any stretch.
At that time, we were still close. When we talked on the phone, we would quote some Star Trek line about "Good God Jim, you can't leave him in the hands of 20th Century medicine!"
(Not the quote, but the rescue scene where the good doctor describes chemo as "sounds like the Spanish Inquisition": https://www.youtube.com/watch?v=MMaGnpVaSGQ)
I was in a really nice facility. I was not crazy. I was just a teenager who had been molested and raped by a relative who was not old enough to legally advocate for myself. (it's a long story)
You would need to do better than merely throwing money at the problem and upgrading our current cages to cushy gilded cages for me to feel that it had some hope of being better than sleeping in a tent in the woods on my own recognizance.
"Bars do not a prison make". And gilded bars do not a civilized climate make by any stretch of the imagination.
Obviously mentally ill, or politically out of favor? I see what you're getting at, and I'm sympathetic. OTOH, history has shown that slope to be unbelievably steep and not very grippy, IMO. I wish I had even the remotest hint where to start to find the happy medium.
Might want to consider that political abuse of psychiatric diagnoses to get opponents or agitators involuntarily committed to asylums or hospitals is not exactly unheard of.
Not stupid you are just young and ill informed.
> While on a phone call with Helen Thomas about the Watergate break-in, King pulled the phone cord from the wall. She was held against her will in a California hotel room and forcefully sedated by a psychiatrist after a physical struggle with five men that left her needing stitches.
The usual argument is there options in between living on the streets and being imprisoned in a mental hospital. My brother is mildly retarded and lives in a apartment complex where there very minimal supervision. He has a car and a job and can come and go as he pleases. 'Supervision' is there mostly to protect him from 'us' not the other way around.
Because no-one has ever been kidnapped for political reasons?
I think there's more to it than that, if we look at some graphs over time.
[1] 2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions. -- https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
The problem with forced treatment is that while there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please, as long as they are not explicitly breaking the law, but prefer non-conventional life choices.
The main problem with enforced norms is that it pigeonholes everyone into "standard acceptable human" categorization, and if you don't fit into it, you become an outlaw.
The western societies had great fun categorizing people into various abnormality groups, leading into practical eugenics (forced sterilizatin) and forced incarceration. See for example [0].
Germany's 1940's escapades brought this arbitrary categorization fad to an end with the holocaust, where it became explicitly clear what the logical end result is when you start mass categorizing people into first-grade and second-grade citizens.
I have close relatives who would have benefitted from forced treatment, but I still prefer a society that does not do this.
True, there is a difference between eugenics and declaring someone 'too sick', but not that great actually since we don't really have a reliable gauge for a persons mental health - hence, it becomes arbitrary categorization based on just not falling within subjective norms of the dominating culture within society.
[0] https://www.nature.com/scitable/forums/genetics-generation/a...
But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report).
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
And, while there are some bad wait times for non-life threatening surgery, I consider the overall system really good. My sister-in-law had major surgery and hospitalization and care was very good.
It's not so strict as a pure "public" service, and there are state-managed hospitals where you can get bad experiences like crowding and bad care, but never to the level you're describing.
And I can (and did) choose to have some better services on top of the basic ones so I have amazing emergency services and same-day specialists, for an extra 200 dollars (on top of my mandatory health tax bill which is also like 500 dollars).
http://www.expatfinder.com/uruguay/expat-guides/article/heal...
My anecdote is that here in the US, if you lose your job and find yourself without insurance, you can literally go bankrupt from a relatively minor injury or sickness due to the extreme cost of medical care. There are plenty of long lines, bad doctors, and low quality hospitals here too so its not like you get rid of those things by going private. People decline to call the ambulance because they are afraid of getting charged thousands of dollars for it if their injury is not covered by insurance which sometimes ends in their death.
I watched my mom die in the hospital and if it weren't for a recent law passed by Obama, we would have had to dip into what little savings we had just to keep her comfortable for her last few days. There is a lot of space for a middle ground that does not need to be limited by your experience or mine.
I never wanted to imply that private services are always high quality, but there definitely is more motivation and it shows - while there might be a considerable portion of bad hospitals in the US, here are literally just a handful below average ones (compared to the US) in my country and it's impossible to get there legally.
Of course low quality hospital beats no hospital, but you should be able to fix that with some kind of mandatory insurance that is state-sponsored if the person is poor, for example, no? Don't forget that I'm reacting to a comment praising public hospitals from control reasons, not about absence of social safety.
I don't understand why people in the US can't or don't pay their insurance themselves instead of through their employer, though. Seems like a huge risk - well you described it.
Your employer can group all of their employees into a single risk pool, so each employee gets a discounted rate. When you purchase insurance on your own you are no longer in a group and so the cost is far more. Doctors are also incentivized to prescribe you drugs you don't need and drugs that insurance covers instead of the correct medication.
My wife had to wait to get surgery on her leg because she just signed up with a new employer and didn't have insurance yet. If she had gotten the surgery without insurance it would have cost somewhere around $100k US.
This is proven to be false by Switzerland, where people purchase their private health insurance themselves.
https://www.quora.com/What-is-the-difference-between-the-US-...
I'm in no way praising the US system though. Just saying that public hospitals have been tried and it's really bad. I think the Swiss system is good.
I'm sure there is a good balance here, somewhere. But what we had and now have isn't it. A better balance feels like it should include a judge, 2 doctors with at least 2 hr patient time for each, and someone else that the patient knows.
Hospitals are dangerous. You lose your sense of autonomy, are woken up throughout the night for blood draws or medication management, and are at risk for nomosocomial infection or delirium.
It’s an emotionally charged place and conflict between families and doctors happens often. Hard ethical questions happen. For instance a young man may come into the ED with massive polytrauma and require immediate blood transfusions to keep him alive. There’s a chance he would be the person to refuse a transfusion on religious grounds, and the family would be upset with our team for ‘violating his body’.
Because of situations like this, or the one described in the cnn article, ethic committees are an essential part of hospital care.
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his own building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
On the other hand I had extremely good experience with cheap private healthcare in Ukraine. I wasn't brave enough to test their public system.
Sorry I didn't mention it, I thought I did but I mentioned just the currency.
Healthcare could always be better funded, but here it's honestly amazing compared to other places I've seen.
We've got this right in law as well (going to a higher court). The downside though is it costs both time and money.
That is enough reason for me to consider this article to be sensasional. It is impossible to say who is at fault.
In general, it often happens that people think they know better than doctors, and in this case she may simply be lucky that she did not get seriously ill. The article itself contains a lot of incoherent quotes and it is impossible to make any sense or argument from it.
Since the hospital legally can present their side of the story and evidence to support it and have chosen not to, it is reasonable to accept the patient's account as accurate.
No one else has claimed she's incompetent. Other mmedical professionals have said she was and is. When patient signed the release, they were free to discuss the details of the case. Their refusal to do so is telling.
The facts of the case are that the hospital engaged with several judges and a police department all of whom ultimately concluded that they had no legal basis to hold her. Yet they had been doing so anyways.
As far as I can tell determining who is at fault is exactly what the legal system is for.
And people are allowed to make stupid decisions! It's not the state's responsibility to automatically defer all control to the residing 'expert'.
In terms of Mayo, they are one of the best hospitals in the world, current situation notwithstanding. It isn’t like the national monopoly one might find in the NHS. Remember a very similar situation happened with Alfie Evans — except Alfie was terminal and had a minimal chance of survival and the U.K. government still refused to allow him to leave the U.K.
Permission to take him abroad was denied by the UK courts, not the UK government.
They're an unintentional advertisement for the benefits of secular government policies.
In the US the Head of State figurehead role and the executive leadership are merged into the President of the United States, while a legislature remains separate. In the UK the Head of State figurehead role goes to a monarch (currently Queen Elizabeth II) but the executive leadership is granted to whichever group controls the legislature as Prime Minister.
I'm British and I can't recall the term "government" being used in this way, even informally. I think most people, even if they're not interested in politics or our "unwritten constitution", would have some understanding that the courts, police, etc. are separate from the government that they elect. They may or may not have a word for what that thing is (the State) but nobody talks about people being "arrested by the government" or "convicted by the government".
I can imagine the people might think of the Civil Service as part of the government though.
In everyday speech, not really. We don't have a codified constitution so things are sometimes a little ambiguous. I guess people might use terms like "the state" or "the powers that be".
There is the legal concept of "The Crown" [1], which is kind of like the legal personality of the state. It sits at the root of a hierarchy, with the executive, legislature, courts, military etc. below it. The monarch, as head of state, exercises the powers of The Crown, although mostly in a ceremonial way on the advice of the government [2]. But nobody talks about The Crown in everyday speech.
[1] https://en.wikipedia.org/wiki/The_Crown
[2] https://en.wikipedia.org/wiki/Royal_prerogative_in_the_Unite...
No, it's not: the ability of conservators/guardians to benefit financially from that relationship is well-known, and is the reason why a legal fiduciary duty exists. The existence of that duty doesn't remove the ability, it just provides a basis for corrective action if it is improperly exploited.
There is also a profound disrespect for human autonomy. Hospitals disrespect autonomy for many people in many ways, with the most common being when birthing mothers get locked in.
In this case, besides the parents, credit goes to a couple judges who denied the Mayo clinic's requests. You'd think one should be enough of course, and that seeking another judge should be prohibited. To give a doctor analogy: it's like hopping from doctor to doctor in search of pills.
Hospitals that do this sort of thing ought to take a fatal hit to their reputation. Nobody should accept being a customer. I suppose the news doesn't get out much, memories are short, advertising works, and most hospitals have a regional monopoly.