Reference no: EM133316335
Case Study: Keven is a 27-year-old man who has severe schizophrenic illness and type-I diabetes. Before treatment in a secure treatment unit, he was treated successively in different settings with good success. He has been brought to your secure treatment unit after he committed a near-fatal assault on a fellow patient in a group home. His stay has been characterized by periods of relative health alternating with periods of depression, paranoia, withdrawal and aggression. During these periods, he talks about hearing "voices" which he claims were the reason he attacked others physically, including staff, in the past.
Kevin refuses to accept his insulin and his schizophrenia medications during periods of depression. These periods of depression have become more frequent which has resulted in increased episodes of withdrawal and aggression. When feeling depressed, Kevin has refused to attend any of the court sessions related to his assault case, and he has frequently been unable to participate in his defense. He has therefore been designated as unfit to stand trial for the offense.
The only treatment that helps Kevin to recover to some degree from his depressive episodes is electroconvulsive therapy (ECT), even though he had once expressed his wish to not receive it when he was capable. Although he has been found incapable of consenting to treatment during depressive episodes, he refuses ECT each time it is presented. Because he consistently refuses his insulin, Kevin must be forcibly restrained while his insulin is administered.
Sandra is a security officer in the unit. She finds it very distressing to have to forcibly restrain Kevin so often as the medical staff injects him with insulin against his will. This is especially difficult for Sandra because she happens to be dating Keven's brother. Sandra has spent time with Kevin prior to the onset of his illness and she believes she can help him. Often, during periods of lucidity, Sandra talks to Kevin about his illness and tries to help him work through his depression. Sandra has taken some psychology classes at the community college and she believes she has some insight into Kevin's condition.
Other staff members are also uncomfortable with restraining Kevin. They feel that restraining him compromises their caring relationship with him. Also, they feel uncomfortable in having to inject him with insulin, which he needs for his type-I diabetes, since he is adamantly refusing. Unfortunately, this is the only way to keep him from ketoacidosis, a serious diabetic complication which could be fatal. Kevin would likely recover from his depression after a few weeks of ECT.
The staff has not forced Kevin to receive his ECT nor his Schizophrenia medications although the ECT will likely successfully treat his depression, and that could result in Kevin agreeing to take his other medications. If Kevin can be stabilized, it is likely that he could be relocated to a less secure facility, and he could eventually be reintegrated back onto a group home setting. He could also be declared competent to stand trial for the assault.
Question 1: Does Kevin have the right to refuse all treatment?
Question 2: Which of the treatments if any might be forcefully administered to save Keven's life? Explain your answer.
Question 3: When there are no health concerns involved, can Kevin be "forced" to receive treatment solely to become competent to stand trial?
Question 4: Are there any ethical implications for Sandra's behavior? Explain.