Douglas Berger, Psychiatrist in Tokyo comments on, “Sex Addiction: Playing Now in Theaters”, By Roberta Zanzonico, MD and Renee M. Sorrentino, MD, Psychiatric Times, January 2018.
Original Article: http://www.psychiatrictimes.com/article/sex-addiction-playing-now-theaters
This article seems mired in needless philosophic details about how to care for this 85 year-old man with vascular dementia admitted to a psychiatry ward and who is a danger to other residents at his care facility, refusing oral and effective valproic acid and requiring several emergency antipsychotic injections. His daughter is ok with spiking his food with valproic acid but against antipsychotic treatment.
It is clearly much more unethical not to treat this man and let him harm his co-residents, nor to have to force injections on him which is a bit cruel. The treatment team is probably more worried about a legal case than ethics. Assuming we did not live in a society with laws, it is simple enough to spike his food/drink with valproic acid solution and tell his daughter to continue to spike his food/drink at his residence or back home. Hopefully he would agree to blood tests, if he doesn’t, the alternative is forcing injections on him that should have blood testing anyway. The answer is a no-brainer.
Because we live in a society with laws, his case should be petitioned by the hospital in court as soon as possible. Until the court date, he can be deemed acutely dangerous to others and that spiking his food/drink was better than forcing injections on him.
-If the court rules he can just have his food/drink spiked for his condition regardless of acute danger, all is well.
-If the court rules his food can’t be spiked/drink unless he is acutely dangerous, then the treatment team can note that his condition makes him acutely dangerous daily (regardless of his actual behavior), and the daughter can decide to do what she feels is right for him, i.e., spike his food/drink when he is discharged, at her own legal risk.
-If the court rules that he cannot be given medication in his food/drink without his permission, regardless of the daughter having medical decision power and her agreement, the case should be appealed. If the appeals court still agrees with the lower court, then the man can be forcibly injected as needed and the case repeatedly appealed. This situation would be a failure of the legal system not of medical care. Ward staff might be able to refuse to take part in involuntary injections, or quit their job, on ethical grounds, further placing the legal system as the cause of a medical-mess.
Doug Berger, MD, PhD
U.S. Board-Certified Psychiatrist
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