One of the most frustrating things I encounter at my job are the patients unwilling to save themselves.

Let me call this sort of patient “A”. “A’s” main problem is he or she won’t do the things necessary to avoid wrack and ruin. “A” won’t take his or her medication, or get sober, or stop taking drugs, or wear a helmet or selt-belt, or avoid bad relationships.  “A’s” loved ones can’t get A to see reason. Often they call me, pleading or demanding I do something about “A” before he or she goes to the devil, or worse, kill his or herself.

For those with psychosis or active mood disorders, it is arguable they are not in their right mind to refuse treatment. Back in the ‘bad old days’ it was rather easy for a doctor or spouse or family member to lock up “A” before they get past saving.  The pendulum has swung to the other side. If A is drinking, doing drugs, refusing to function, take their medications etc. there is little anyone can do anymore. “A” has to be literally at immediate harm to self or others to get treatment against their will. Even this is hard to do. Lots of times I’ve gone to court to support “A”s family to force “A” to get help.  A’s lawyer usually argues “A” has the right to do what he wants, it is a free country, and I am an evil person who wants to deprive “A” of liberty.

As taxpayers, should we refuse to support a person costing society with their (bad) choice?  I remember a patient ‘Sydney” who was in and out of countless hospitals and halfway houses as he would immediately stop his medications upon discharge, go crazy, only to be picked up again by the police who would dump him back in the ER, only to repeat this over and over. He cost the State of Illinois a fortune; I suspect he still does and will do so until he either kills himself or accidently dies from his poor judgment.

Even more ‘gray’ is somebody not ‘out of their mind’ but refusing treatment or demonstrating poor judgment.  Grandpa refuses to stop driving, despite all recommendations it is dangerous (and to others).  Wives call me, pleading me to ‘do something’ about their depressive husbands who refuse to follow doctor’s orders. “There is nothing wrong with me!” they say while sliding towards disaster obvious to everybody but they.  Parents are overwhelmed their teen refuses to stop drugs.  What about HIV patients, who had unsafe sex? There are many examples.

Ultimately we are powerless to prevent another person who chooses to say ‘no’.

So what do we do with people who refuse to do what Medicine recommends?  I don’t have easy answers for this.

Paradoxically the USA is currently on two high horses:

Individualism/I can do what I want/No one can tell me what to do

and

Accountability – particularly to others.  “Nothing needs reforming so much as other people’s habits” said Mark Twain. If someone screws up, I don’t have to pay for your actions/folly/decisions.

Good luck all reconciling these two issues.

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