Friday, January 16, 2009

Prisoners and Consent

This week in class we talked about whether prisoners/inmates had a right to refuse (or decline) medical treatment or if they could be forced to undergo treatment. Several people felt that such individuals could be forced to recevie therapy, while I was under the impression that this was not true. I decided to look into this and here is what I found:

In, "Fundamentals of Emergency Care" by Beebe & Funk (Florence, KY: Cengage Learning, 2001), the authors state, "Although an individual who is imprisoned does not lose the right to make decisions regarding medical treatment, many states have enacted laws regarding medical treatment of incarcerated individuals." They continue, "If however, the prisoner refuses treatment, further care may not be provided unless another individual is authorized to consent on the prisoner's behalf."

I was able to find the official Washington State Department of Corrections policy on "Offender Consent for Healthcare". Overall, it states that inmates should be provided the same information as any other patient regarding the risks and benefits of care, but that at certain times, this decision can be over-ridden in the interest of public safety. I think applicable passages are: "VI. Refusal of Health Care Services. A. Offenders capable of providing consent have the right to refuse examinations, treatments, and procedures, whether invasive or non-invasive, after having been provided with the information listed in the General Requirements section of this policy." As well as: "E. The right to refuse treatment does not apply when the treatment is allowed or required by statute, case law, policy, court order, or when the condition requiring treatment is self-induced and failure to intervene poses a risk of significant harm. [4-4397]"

For more information and some interesting discussion of the care of prisoners in the ER, you can also check out Moskop JC. "Informed consent and refusal of treatment: challenges for emergency physicians." Emerg Med Clin North Am. 2006 Aug;24(3):605-18. This article reviews a lot of the issues we discussed in class and finishes with a discussion of some recent legal cases regarding medical care of inmates as well as some case examples that an ER provider might face.

One other thing to toss out there: occasionally suspects are brought in by police officers for medical care. It used to be that they would be left there a long with a card to contact the police officer when the patient was okay to be released. However, due to confidentiality of patient records, at least at Harborview, we now have to obtain consent from the patient to call the arresting officer. If the suspect does not consent, we either can't call when the patient is released from medical care, or the officer has to remain at the patient's bedside for the duration of care.

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