Mental Health Groups Want to Preserve Advanced Directives

A bill characterized as an administrative fix has drawn opposition and a close vote in the House
The Lund Report
April 29, 2011 -- A bill that would allow caregivers to ignore psychiatric advanced directives in certain cases of involuntary commitment has drawn opposition from the mental health community. After narrowly passing the House, it now moves to the Senate.
House Bill 2107 passed the Oregon House by a 32-to-28 vote on April 5. This week, it received a hearing in the Senate Committee on Health Care, Rural Health and Human Services where mental health advocates continued their opposition.
The state can already ignore psychiatric advanced directives for patients who are civilly committed. The bill would extend that ability to forensic patients as well. In both cases patients are committed by a judge, but only in forensic cases have patients committed a crime.
“Without it, the hospital would increase seclusions and restraints,” said Greg Roberts, superintendent of the Oregon State Hospital during a House committee hearing in February. “Assaults on staff would also increase. The point of the change is to have one set of procedures and rules based on one statute.”
Providers can still involuntarily medicate forensic patients now through a judicial process, but it just takes longer and requires more staff time.
“It’s very common for patients to refuse medication while at the hospital,” Roberts said. “This can result in prolonged hospitalization and additional suffering.”
But various mental health groups, including NAMI Oregon and Mental Health America of Oregon, oppose the bill, and have used the opportunity to assert basic rights. What’s the point of advanced directives, they say, if providers won’t observe them when patients can no longer make rational decisions?  
“This is not simply someone saying no medication,” said Meghan Caughey president of the Mental Health America of Oregon. “Many people will say what works best for them or that they’ve had some severe side effects with others. This is a way of giving providers more information than they might have otherwise.”
Caughey fears a policy that disregards the wishes of patients might create an atmosphere of distrust. “We want patients to be motivated to work with providers as a team and not as adversaries,” Caughey said.
Carol Gundlach with NAMI Oregon said she was surprised the Oregon Health Authority brought this bill forward. “Patients have the right to refuse medication and make their own determinations to execute advanced directives on a proactive basis,” Gundlach said. “I don’t have an issue with overriding them in certain cases, but I have a big issue with a patent disregard of a document.”
Mary Botkin, a lobbyist with American Federation of State, County and Municipal Employees, which represents workers at the Oregon State Hospital, said allowing providers to ignore advanced directives increases safety and improves care for patients throughout the hospital.
“These are the sickest and most dangerous clients we have,” Botkin said. “It’s not reasonable to expect that other clients should be placed at risk because a person decides they don’t want to take their medication.”


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Just like ALL LAWS, this one will be applied across the board to everyone. It WILL NOT just be applied to the "sickest and most dangerous". It is insidious.

I believe this is not a good bill to pass. Too much power given without professional evaluation. It is not fair to patient or their loved ones. It could be dangerous to those who can't speak for themselves.

THIS BILL IS DANGEROUS TO THE LIVES OF EVERYONE UNDER THE "MENTAL HEALTH" SYSTEM!!! As someone speaking from almost 2 decades of experience, what this will result in are situations where staff inside of the State Hospital (and other state-run care facilities) can apply a "chemical straightjacket" to patients who they deem to be "uncooperative." THEY CAN ALREADY DO THIS, AS LONG AS THE ATTENDING PSYCHIATRIST CAN GET A SECOND OPINION FROM HIS BUDDY WORKING ON THE WARD NEXT DOOR!!! Of course, chances are high that one or both doctors are marginally-skilled, at best, given that they are working at a job their own peers consider sub-standard (and that's putting it nicely). What happens next is a bit of "creative writing" in the patient's medical charts that will read something like, "...patient looked agitated and began to raise his fist at a staff person... we had to take him down, strap him down, and shoot him up so he could go to a happier place..." BEEN THERE, DONE THAT - AND IT'S A LOAD OF BULL!!! The existing protections for forensic patients are already so weak that patients still get "accidentally killed" by staff who administer the wrong injections in the wrong-sized doses (Benjamin Bartow, anyone???). The last time they came to me asking about "advanced directives," and DNR (Do Not Resuscitate) Orders, I said, "Well, could I get a DNA Order? DO NOT ASPHYXIATE!" It was an appropriate bit of nervous humor at the time, considering they'd recently smothered one of my friends to DEATH! (Benjamin Bartow, anyone???). Legislators who sign this bill are essentially endorsing the precursors to what could soon become a policy of euthanizing (MURDERING) patients that the State deems to be "criminally insane." Sure, you've got a "Ted Bundy" or two in every State Hospital, but for every one of them there's 300 who aren't THAT crazy! Pretty soon, the State could be "accidentally killing" people who get "hospitalized" for breaking TV screens at Best Buy because they think that God told them to do it! So, really, I only have one more thing to say: "BENJAMIN BARTOW, ANYONE...? ANYONE...? ANYONE...?"