Medication Refusal in Schizophrenia: Preventive and Reactive Ethical Considerations.
Clinicians treating patients with recurrent psychosis should encourage contingency planning with patients and families for how to respond to potential recurrences. Whether or not patients create a formal psychiatric advance directive, patients, families, and clinicians will be better prepared to deal with emergencies if they include "scenario planning" as part of ongoing clinical care. In the case under discussion this was not done, resulting in an ethical conundrum as to whether it was ethically justifiable to override the proxy decision maker's refusal of medication. Law on this question is unsettled, but the author argues that from the perspective of ethics, overriding medication refusal is sometimes ethically permissible.
Clinical professor in the departments of population medicine and psychiatry at Harvard Medical School in Boston, Massachusetts, and the director of the ethics program at Harvard Pilgrim Health Care.
James
J
Sabin
D032722:Advance Care Planning; D003657:Decision Making / Q000941:ethics*; D004630:Emergencies; D004992:Ethics, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D019727:Proxy; D011618:Psychotic Disorders / Q000188:drug therapy*; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy*; D016312:Treatment Refusal