Re-Posted
I thought that would introduce a new segment to Where’s the Outrage – medical ethics.
A 20 year old female presents to the ER. She complains of feeling like somebody is trying to get into her head. The patient looks scared and anxious. Her eyes are darting back and forth. Her speech is pressured and rapid. You are the ER physician. You run a battery of tests and conclude that the patient may be a danger to herself. You ask her if she will be willing to come in the hospital for some treatment that you think will help her. She agrees. As soon as you walk out of the room, the patient is seen by the charge nurse trying to leave.
What should you, as the ER physician, do?
I don’t know how much ethics have changed since I was in school to be a counselor (which I was, sadly, unable to complete due to my illnesses,) but based on what I learned then, if you believe someone is a danger to themselves or others, you have an obligation to see that they are safe, usually via an involuntary commitment to a psychiatric ward.
First, I would call for security to prevent her from leaving. I would hope that, after running the tests and seeing the results, but before talking to the patient, I would have called for a psych consult, meaning that there should be a psych specialist over to see her shortly. If I haven’t called for a psych consult, I would do so immediately after making sure the patient is protected.
I would then contact the hospital’s legal department to see what needed to be done to make an involuntary commitment, assuming the psych consult backs up my concerns.
I believe that the Tarasoff decision would also mandate that I contact her next of kin to report that she may be a danger to herself – I’d want to review that with the legal department also before doing anything, though.
Now, if things have changed since I was in school (which was, admittedly, about a decade ago) I’d have to know what those changes are to know for sure what I would consider the ethical thing to do, but given the information I have, I think the above would be the most appropriate course of action.
I’m not sure that things have changed that much in ethics. Self-determination is a big principle.
Thanks for your thoughtful comments.