Ethical Lines Drawn Oh So Finely

            Recently NPR ran a story that briefly discussed a historical anecdote involving a young man who suffered an accidental gunshot wound to the abdomen, leaving him with an interesting condition known as a fistula. Essentially, the man’s wound never completely healed, leaving an opening to his stomach covered by a simple skin flap. He continued to live a fairly normal life although his condition obviously prevented him from engaging in certain types of work. A doctor was very interested in this condition and engaged in some experimentation, similar to the work of Galileo in which he would tie a string to a piece of food, swallow it, and then pull it back up at various times after ingestion to observe the progression of digestion. This doctor, however, bypassed the esophagus completely, directly inserting the food item into the stomach, and conducting similar observations by removing the food and documenting stages of digestion. Of course the doctor provided the man with compensation for his participation. Even so, this man decided that he didn’t want to be a guinea pig anymore, left the service of the doctor and attempted to live a normal life.

            As previously noted, this man could not participate in certain types of work. His life was difficult, and at a point it became evident to him that he needed the income provided by the doctor to participate in these experiments to live. He was forced to return to the doctor and allow him to conduct these experiments simply so that he could have enough money to live. The man had no other choice, he could not work and support himself due to his condition so he had to return to a situation that he was extremely uncomfortable with simply to survive.

            Back then we had no disability income. There was no other option that the man knew of, and this benefited the doctor (and in a way science as a whole) because the research could be completed. Even with the wonderful advancements that it provided, it was essentially against the man’s will, and therefore should be considered unethical. Even with the obvious ethical dilemma this situation, even by today’s standards, would provide no issue with any board of ethics since the man came “willingly” and was compensated.

            This situation brings up so many questions regarding ethics in today’s world of psychology. I’ve worked in an inpatient unit. There I learned about the very interesting concept of declaring people incompetent to make decisions for themselves. Given their incompetence the treatment team can force medication on these people. There are certain medications that we can give by injection providing a long term, extended release that can last up to 60 days. Mental health incompetence generally would not last quite that long. A crisis situation can be resolved with less serious medications and therapies within as short of a period as a few days. The interesting thing here is that, during this window of “incompetence” doctors can make the decision to give them a medication, against their will, that would last for 2 months. A mentally competent individual can refuse medication even if it may be helpful.

The choice to struggle with or without medication (for whatever reason) is a right of every man, woman, or child that is confronted with that decision. For us as professionals to rob the individual of this choice, be it for days or months, is an injustice as far as I am concerned. In this field we are here to help, and part of helping is to respect the wishes of those with whom we work, whether we agree or disagree with the decisions that they make.