General Question

cardiacmusings's avatar

Do you think doctors are more likely to use psychiatric patients as "guinea pigs" for controversial treatments?

Asked by cardiacmusings (67points) January 11th, 2011

More specifically, do you think they are more likely to be coerced into agreeing to a treatment that someone of sound mind would turn down?

I have an escalated interest in this after witnessing how my Mum was treated, her doctor had her sign off on getting ECT (Electroconvulsive therapy) after an extensive hospital stay. She had been diagnosed as not “sound of mind” and “unable to make rational decisions”. At this point, do you think they should have called in next of kin to discuss the options BEFORE having her agree to the procedures?

ECT’s are already highly controversial in the field of psychiatric care, particularly in the United States. So, to convince someone who is ill already that they should undergo extreme treatment – even though they have already been told they are incapable of rational thought – seems absurd to me.

The doctor was not thorough with his explanation of what it would entail or how it would effect her afterwards. Her memory was greatly impacted and still (over one year later) has not returned to normal. Not to mention that (in my knowledge) inducing seizures in the body can be harmful both for the brain and the body. She has experienced many side effects with almost no lasting positive results. Had she been of sound mind, she would have said no and potentially avoided a lot of pain that has followed these treatments.

What are you thoughts on the coercion of committed psychiatric patients and controversial medical treatments without speaking with spouses or children?

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17 Answers

anartist's avatar

Normally, doctors make a distinction between patients who are rational enough and have enough contact with reality to make decisions for themselves and those who are not. From what I know of it, ECT is a treatment of last resort for major depression. If this is what your mother has, reason may be weighed down by depression but is not necessarily absent. A severely schizophrenic patient may be a different matter.

Did your mother not speak to you about it? It is her doctor’s duty to keep her confidence unless she specifically requests family involvement, as long as she is considered rational enough to pay her bills, vote, and generally live in this world without a sheltered environment.

Where mental incapacitation is extreme, there is also a legal step, the surrender of power of attorney [say to a family member]. This is a step no family member would want, as it publicly, through the judicial system, declares the relative not of sound mind.

Winters's avatar

Sadly, many doctors are in for money and will try to wring every last drop of cash they can out of you. This sounds like it may have been such a case as I am sure that people who are deemed to be not sound of mind aren’t supposed to be permitted to make such decisions on their own unless there is no one close to the individual in question.

I am no expert in the medicinal or law field and suggest you look it up yourself or perhaps ask an attorney who has knowledge of medical law.

cardiacmusings's avatar

@anartist – I appreciate your response but perhaps my question was misinterpreted. I am not looking for clarification on what to do if my mother was coerced by her doctor or wrongly treated (as we have handled that privately with the hospital already). I was not looking to have her specific case examined so-much-as I was using it as an example to follow up the question. I do not wish to go into extremely detailed accounts of her illness; I will just say that, in her case, the doctor was bound to inform the next of kin of any treatment alterations before moving forward.

I’m more interested in both yours and @Winters thoughts on the question itself. Like I said, I’m not looking for advice on how to deal with this situation pertain to my mother. I’m interested in what people think about committed psychiatric patients (generally implying that their reasoning is impaired in some major way) being used to further studies on controversial treatments. :)

perspicacious's avatar

No. Doctors are very careful about informed consent—- too many lawsuits.

MissA's avatar

What do I think? As a general rule, I’m not up for seeing any mammal, humans included, to be subjected to extreme experimental treatments. That said, there are going to be exceptions, determined by the family of the human in question.

nebule's avatar

I thought there were laws in place to prevent this kind of stuff… the American Psychologists Association… Code of Ethics and such like…. Coercion of any kind is strictly against the CoE as far as I’m aware.

BoBo1946's avatar

I hope not, it could be me.

JLeslie's avatar

I don’t think ECT is considered highly controversial. And, I don’t think doctors use it in present day as experimenting on patients. Memory loss is simply a side effect of the treatment, it is a fact. I find it hard to believe she was not warned about it. I think the memory loss aids in the patients ability to overcome their depression, even though it is upsetting to realize someone loses months of their life experiences. I know more than one person who has had great relief from their depression from ECT, and ask for it when they are in major depressive episode. ECT is considered to be one of the most effective treatments in severe depression.

From your description it seems her memory loss was more severe than typical. I am sure that must be very upsetting to you. Is she concerned about it as well? Did her mental state, aside from the memory loss, improve after the ECT? Also, the medications she is being maintained on can greatly affect memory, possibly that is part of her memory difficulties?

Having said all of that, there are crappy doctors. Had you been actively involved with her treatment before they decided to do the ECT? That you would have logically been in on such a discussion regarding her treatment.

I am very sorry you are dealing with this. Mental illness can be very scary, and medical decisions, for mental or physical health, trying to ensure your family is being taken care of properly, and not harmed more, is extremely stressful.

JLeslie's avatar

I forgot to say that ECT is generally not thought to be a permanent cure. There is an expectation that its affects will fade, and that is why there is continuing treatment with therapy, and many times medications.

Simone_De_Beauvoir's avatar

I think some doctors (and they’re plenty unethical ones out there) would consider psychiatric patients as well as elderly or homeless or incarcerated patients as someone they can use as guinea pigs – many doctors (just like many others in power) consider these populations expendable.

cardiacmusings's avatar

@JLeslie Your response was very thorough but, like I told another poster, I was not looking for someone to dissect my own scenario. I am well-versed in the areas of ECTs, mental illness and patient care and was simply providing an example.

@Simone_De_Beauvoir , it is unfortunate how true that is/feels.

tranquilsea's avatar

People who are suffering from a mental illness are at increased risk of being taken advantage of. It is very important that the patient trusts the psychiatrist/therapist and that the psychiatrists are trustworthy. In a perfect world this would happen. But we don’t live in a perfect world.

When I was desperately depressed I was offered ECT. The hospital staff did a bang up job explaining it to me but I still declined. They didn’t know, imo, enough about why it works or how I would be effected to make it be something I would try. The process is very irreversible. At least with a medication I can stop it if I have adverse reactions.

I spoke with a couple of people who had had ECT and were back for maintenance sessions. They both experienced memory loss. One lady had to keep all her kitchen cupboards open because she could never remember where anything was.

Too many therapists are interested in curing your problems ASAP. When in reality many people need years of therapy to undo a lot of crappy life experiences. A pill won’t magically make my past any better, nor will ECT.

Psychiatric patients have been grossly mistreated in the not-so-distant past. Without a ton of diligence we could be back there easily.

JLeslie's avatar

@tranquilsea I think with extreme depression there is a fear we will never get to help thepatient with ongoing therapy if they are suicidal. I agree with your point that in the not so different past the mentally ill were mistreated and I would say even expiremented on. Not necessarily out of cruelty or bad motives in general, but because the medical just did not know what the fuck they were doing. To some extent it is still guess work. Each individual is so different.

The system also, with limited insurance coverage, seeks fast cures to get a patient well enough to be discharged.

tranquilsea's avatar

@JLeslie I can understand that point. But I think, from my observations, that they want you treated and out of the hospital asap. They used to release me out into the community with no back up support and then they were surprised when I ended up in ICU a day later. They were not the hospital that recommended ECT. That recommendation came from my regular psychiatrist who admitted me for 8 weeks at one point.

I was a really tough case. I know I tried the patience of many a psychiatrist. None of them, in the beginning, wanted to invest any time with me. I only started getting better when I found a psychiatrist who was willing to do so. Thirteen years later…thirteen years of intensive therapy and I am finally able to cope with the traumas of my past.

JLeslie's avatar

@tranquilsea We had a lot of patients with diagnosis like schizophrenia, who went in and out like a revolving door. We always discharged patients with a place to follow up though. Certain mentall ilnesses, once a patient was stabilized, they could upgrade and start therapy, but others never really got to that point. Everyone had a therapist assigned to them, not only a psychiatrist, but some people are not working through issues, but are treated more strictly as having a chemical imbalance, or unable to understand certain concepts. It depends on each individual. Of course people slip through the cracks, and some doctors are better than others.

My grandfather was paranoid schizophrenic, but he was a gentle man. He functioned well enough to work and provide for his family. He was, what I would refer to as, experimented on with ECT and medications. They just did not know what they were really doing I think. Saddens me greatly when I think about. The Kennedy tragedy also comes to mind, Rosemary Kennedy. The labotomy that was preformed on her that left her in a horrible state. Just awful.

We need better ways to help the mentally ill.

tranquilsea's avatar

@JLeslie I agree completely. Too often, when cuts are made to health care, mental health is the first to be cut.

I was going through the worst part of dealing with PTSD at a time when governments were closing down psych. wards with promises of community based help that never materialized.

In my province and country it looks as though they are trying to go in the right direction so far as funding and awareness go.

The most important thing you can have as you traverse the mental health field is a good advocate. If you can’t be your own then it is important to find someone who can be.

anartist's avatar

Patients, even voluntarily committed patients [voluntary in the sense that they will be involuntarily committed if they don’t do it voluntarily] still have the right to informed consent, even consent to be a guinea pig. Some universities offer free in-patient treatment for depression and other illnesses as part of a drug testing protocol but also including therapy. A patient can choose to accept this free treatment with guinea pig aspects or choose to pay top dollar for treatment, or if rejecting all choices, be sent to a state hospital [not desirable]. As long as a patient can make reasonable choices, they are encouraged to do so.
I know. Believe me, I know.

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