Wednesday, July 13, 2011

Whose rights come first?

A while back I had blogged about the Arizona shooting. Because I work in behavioral health nursing I've got a pretty keen interest in how the story unfolds, and so I've been following the case pretty closely. I'm excited for Senator Gifford, her progress in her recovery is nothing short of amazing, as is the recovery of all of the people wounded that day.

I've been very curious to see how the legal system would handle the case against Jared Loughner. He's been declared mentally incompetent, and is now being held in federal custody, in a secure psychiatric facility. He continues to be violent, has attempted to assault both his doctors and his attorneys on several occasions (which I can guarantee means he's also assaulted the nursing staff, but of course nurses are far less news worthy than doctors so that never even gets mentioned), and was refusing all medication. So, his psychiatrists, being trained medical professionals who have years of experience dealing with potentially violent delusional paranoid patients who have no insight into their illness, took the appropriate action, which was to order that Loughner be forcibly medicated.

For those of you who don't know how this works, this means that Loughner would be offered the option of taking his medication voluntarily, most likely in pill form. If he refused, he would be restrained for his and the staffs safety, and the medication would be given in the form of an injection.

I've had to administer medication this way on several occasions, and it's not something that anyone working with the mentally ill looks forward to. It's frightening for the patient and dangerous for the staff. I've been punched, kicked pinched and bitten administering medication to patients who were being restrained and managed to get loose. Forcible medicating is not something that's done lightly, and is always a last resort. It's only used when the patient is clearly a danger to themselves and others, has no insight into or understanding of their illness, and is unable to determine reality from delusion. Jared Loughner would have had to meet all of these standards before an order to forcibly medicate him would have been written.

Unfortunately, Loughners lawyers did what lawyers tend to do, and filed an appeal to stop the forced medication administration on the grounds that it was a violation of Loughners rights. At the initial hearing a judge upheld the doctors orders on the grounds that Loghner was not legally competent to stand trial for the murder of 6 people and the attempted murder of 13 others, due to his mental illness, and therefore was also not competent to make medical decisions for himself.

And here's where things start to piss me off.

Loghners lawyers appealed the decision, and a 3 judge panel agreed that he has the right to refuse his meds.

This is one of the stupidest things I've ever heard. Loughner is SO delusional that he murdered 6 people, including a 9 year old girl and a federal judge, shot a US congresswoman in the head, and wounded 12 other people. He is so disconnected from reality that he is not competent to be held legally responsible for his actions, yet he has the right to make decisions regarding which medications he will or will not take?! He has the right to refuse medication that can treat his delusional state, thereby making him less of a danger to the other patients in this facility and the staff that has to work with him?

This is where the lack of understanding about mental illness by the legal system becomes glaringly apparent. Loghner is a newly diagnosed paranoid schizophrenic in his first psychotic break. There's no telling how long he's been in a delusional state, although based on stories from family and former friends and classmates it's probably been building for several years. Loghner has no understanding of what is real, he sees plots and conspiracy everywhere he turns, and he tried to KILL A CROWD OF INNOCENT PEOPLE. What more information does anyone need to prove that this man is in NO condition to make health decisions for himself?

If Loughners attorneys are so concerned about protecting his rights, then what about his right to participate in his own defense? He won't be able to do that if he's in a delusional state. Then again, that may be the goal - to keep him in a state of mental incompetence, so he's not able to understand the consequences of his actions, and therefore cannot be held legally accountable for them. It's actually a clever criminal defense strategy - if he's never brought back to reality, then he can never be held responsible. So what if he's a danger to the people who are attempting to care for him? So what if some staff member who has a family to support ends up being injured or killed bacause Loghner can't separate reality from his paranoid delusions? Isn't it more important that he be given the right to refuse to be treated, even though he's incapable of understanding the danger of that refusal?

I'm sure that his attorneys will be able to explain that to the next nurse or doctor that he assaults.

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