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Blog copyright Mark Antony Raines
Lloyd I. Sederer, M.D. Adjunct Professor, Columbia/Mailman School of Public Health Medical Editor for Mental Health, Huffington Post/AOL
All patients have both a right to treatment and a right to refuse treatment. These rights sometimes become the centerpiece of debate and dispute for people who are hospitalized with an acute psychiatric illness.
The Right to Treatment
There is a long legal history on the right to treatment. Much of the law derives from court cases in the previous century involving people who were admitted to state psychiatric hospitals where they languished without proper treatment, sometimes for many years. Laws compelling a right-to-treatment law developed and became instrumental to the quality-controlled public psychiatric hospitals that exist today. In fact, in order for public psychiatric hospitals to receive Medicare and Medicaid (and other third-party) payment, they must obtain the same national certification as academic medical centers and local community hospitals. For patients and families, this means that a person admitted to a public psychiatric hospital has a right to receive—and should receive—the standard of care delivered in any accredited psychiatric setting.
The Right to Refuse Treatment
It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.
Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital. But a person admitted involuntarily, due to danger to self or others, cannot leave, at least not right away. However, despite having the authority to keep the patient in the hospital, the professional staff cannot treat the person against his or her will, except by court order.
The concept of a right to refuse treatment was built on basic rights to privacy, equal protection under the law, and due process. In other words, involuntarily hospitalized patients still have a right to decide what happens to their bodies.
Unfortunately, the right to refuse treatment can, and does, result in some patients being locked up in a hospital where doctors then cannot proceed with treatment. What’s worse, and deeply ironic, is that insurance companies may refuse to pay, stating there is “no active treatment.” This state of financial affairs, by and large, does not happen in state psychiatric hospitals, which represent the true safety net of services for people with serious and persistent mental illnesses, because these hospitals are not wholly dependent on insurance payment and cannot refuse to treat someone who cannot pay.
Exceptions to the Rule
There are exceptions to a patient’s right to refuse treatment. In an emergency, all bets are off. A doctor may provide involuntary treatment, usually a medication given by injection or by mouth, but only to control the emergency—which, again, is defined as “an imminent danger to self or others.” Whatever treatment is provided in an emergency cannot be continued after the immediate danger has passed, unless the patient agrees and gives informed consent. Clinicians cannot continue the medication, even if it could prevent another emergency situation; the patient has the right to decide whether to continue or not.
For involuntary treatment (treatment without consent) to be delivered outside of an acute emergency, the doctor and hospital must petition a court to order it. Laws vary from state to state and, of course, no two judges are alike.
Generally, judges rule in favor of well-prepared doctors and hospitals that show that
the treatment is necessary for safety and recovery;
all efforts at voluntary treatment were exhausted;
family and others were engaged to help persuade the patient to accept care (and were not successful); and
the benefits of treatment are likely to outweigh its risks.
Inpatient stays often last several weeks (or months) longer if court-ordered treatment is required. Notably, as clinicians have seen, once a court order is obtained, almost all patients comply with treatment within a day or so, and then, hopefully, proceed to respond to treatment.
Jonathan Haber has been a company founder and CEO, an executive and Director at publicly traded, privately held, and non-profit organizations working at the intersection of education, employment, and assessment. He is author of multiple books, including the best-selling Critical Thinking, part of the MIT Press Essential Knowledge series. His unique One Year BA research project on massive open online courses (MOOCs) was featured in The New York Times, the Chronicle of Higher Education and other publications.
Most recently, he has been working as a consultant for for-profit and non-profit educational organizations in areas such as academic standards, innovative online course development, and COVID-response teacher preparation.
Jonathan believes the key to educational equity is to help every student develop critical-thinking skills that can be mastered by learners of any age or background. His books, curricula, as well as the high-leverage critical-thinking teaching practices he developed for educators are all focused on a single mission: to make every student a critical thinker, ready to thrive in the twenty-first century.
How the concept of critical thinking emerged, how it has been defined, and how critical thinking skills can be taught.
Critical thinking is regularly cited as an essential twenty-first century skill, the key to success in school and work. Given our propensity to believe fake news, draw incorrect conclusions, and make decisions based on emotion rather than reason, it might even be said that critical thinking is vital to the survival of a democratic society. But what, exactly, is critical thinking? In this volume in the MIT Press Essential Knowledge series, Jonathan Haber explains how the concept of critical thinking emerged, how it has been defined, and how critical thinking skills can be taught and assessed.
Haber describes the term's origins in such disciplines as philosophy, psychology, and science. He examines the components of critical thinking, including structured thinking, language skills, background knowledge, and information literacy, along with such necessary intellectual traits as intellectual humility, empathy, and open-mindedness. He discusses how research has defined critical thinking, how elements of critical thinking have been taught for centuries, and how educators can teach critical thinking skills now.
Haber argues that the most important critical thinking issue today is that not enough people are doing enough of it. Fortunately, critical thinking can be taught, practiced, and evaluated. This book offers a guide for teachers, students, and aspiring critical thinkers everywhere, including advice for educational leaders and policy makers on how to make the teaching and learning of critical thinking an educational priority and practical reality.
Product details
Publisher : The MIT Press; Illustrated edition (April 7, 2020)
When Danielle Boatman inherits Marlow House, she dreams of turning it into a seaside bed and breakfast. Since she’s never visited the property, Danielle’s not sure what awaits her in Oregon. She certainly doesn’t expect to find one of the house’s previous owners still in residence. After all, the man has been dead for almost ninety years—shouldn’t he have moved on by now? Charming Walt Marlow convinces Danielle the only way he can move on is if she solves the mystery of his death. Danielle soon discovers her real problems may come from the living—those who have their sights on Marlow House’s other secrets.
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