I was recently confronted with a situation that has caused me to again rethink the use and abuse of the power that we have as professionals- especially those with the title of “doctor.”  In my line of work, I am often confronted with difficult and emotional decisions that involve personal rights and freedoms.  I provide opinions regarding the capacity of persons to drive, manage finances, and live independently.  Most of the cases I am involved with involve various degrees of memory loss, sometimes to the point of impairment known as dementia.   Dementia presents as an irreversible loss of ability and coping skills.  Depending on the severity of the dementia, rights such as the freedom to come and go as one pleases must be removed for safety.  These are often gut wrenching for both the afflicted individual and those who love them.

A recent case forced me to revisit these issues from a new perspective.  The case involved someone suffering from a delirium rather than a dementia.  A delirium is a temporary and reversible confusion with loss of judgment and decision-making ability and may involve danger to self or others.  The person I was working with induced a delirium by consuming a large amount of alcohol (alcohol intoxication/poisoning).  This person was clearly a profound danger to self and clearly fearful and stressed underneath the confusion and intoxication.  They were appropriately protected from harm by involuntary treatment (known as the Baker Act in Florida).  The Baker act serves to protect against harm and involves a 72 hour observation period.  If after 72 hours the person is no longer of harm to self, their rights are restored.  This is a legal protection we all have against overly restrictive and coercive treatment.

After sobering up, less than the 72 hours, this person was given the option of entering “voluntary” treatment for alcoholism as they had cleared of the delirium and were thinking clearly and of no immediate harm to self. The Baker Act was then appropriately lifted.  However, the person was coerced into treatment by the threat that if they did not pursue treatment as directed, they would again be subject to the Baker Act and involuntarily returned to treatment.  This was justified as therapy but not only violated the person’s rights but also was exploitive, deceptive, and abusive.  We have no right to abuse legal rules that protect individual rights even if we are trying to keep someone from making a poor decision again in the future.  This is not therapy but rather is dishonest and contrary to therapeutic needs – in this case to help the person regain control via therapeutic alliance rather than strong arming the person into treatment over which they had no control.  Fortunately this case was resolved without legal intervention but the added stress was quite unnecessary and inappropriate.

I hope I personally do better by those who work with me and trust my counsel.  Sometimes it is necessary to use “parenting techniques” and “exaggerated communication” for those who are confused to reduce stress and promote safety.  However, it is also important for professionals to tailor their interventions to the competent individual without coercion or exploitation of their vulnerability during times of intense stress.   It is also necessary to closely involve caring family members in the treatment from the start and to treat the person rather than the diagnostic label.  I don’t want to be treated as an alcoholic or an Alzheimer’s patient.  I want to be treated dignity and compassion individual no matter what the label or standard protocol.