Psychiatry and Bioethics: A Threatening Discrepancy

A 2006 journal article entitled “When psychiatry and bioethics disagree about patient decision making capacity (DMC),” by P.L. Schneider and K.A. Bramstedt, explains a situation in which an 81-year-old veteran, previously diagnosed with chronic paranoid schizophrenia, was found living alone in his non-functional car and was admitted to the Veterans’ Administration Medical Center. He refused subsequent treatment and was analyzed by two different standards to determine if he was capable of making an informed refusal.
The first standard, and the standard that carried more weight, was the psychiatric evaluation, which based its questions on whether or not this man was a danger to himself and others and whether he could take care of himself on a daily basis. He passed this part of the evaluation. However, the second standard, which was the bioethical standard, asked whether he understood his medical condition and the consequences of refusing treatment. The man did not think that the doctors had told him about any medical condition, he failed to understand what schizophrenia was or what the consequences of this untreated disease were, and he could not give coherent reasons as to why he did not want treatment.
I believe that this situation poses grave medical problems and it highlights one of the key flaws of the health care system. As much as it matters that an individual will not hurt other people and will not immediately die without treatment, I think that the bioethical concerns should be more important that the psychiatric ones. This man, homeless, alone, and reclusive, was not living a healthy life and he was in no position to make medical decisions for himself. I think that we should revise the legal standards for when we can detain people because of psychiatric illnesses and we should include the bioethical concerns in the standard psychiatric questions asked.