September 5, 2009
Ethics Department
What Are the Medical Ethics of Forced Catheterization?
I don't understand how stuff like this happens:
According to the suit, police arrested Jamie Lockard, 53, on suspicion of drunken driving in March.
A Breathalyzer test showed he was under the legal limit, but Officer Brian Miller doubted the findings.
Lockard and his attorney claim in the suit that police took him to Dearborn County Hospital and forced him to submit to a urine and blood test.
Police said they obtained a warrant, but Lockard's attorney said his client was shackled to a gurney and had a catheter inserted against his will.
Scott Greenfield discusses some of the legal issues in his post "Places No One Should Ever Go", but I'm wondering about the medical ethics. I've been dealing with a lot of doctors lately, and they all seem to follow the ethical requirements that medical procedures should only be done (A) with the consent of the patient, and (B) for the benefit of the patient.
Sticking a tube up some guy's penis to see if there's evidence to convict him of a crime meets neither of these requirements, so I'm a bit surprised that medical personnel are willing to participate.
Knowing as little as I do about medical ethics, I decided to see what the AMA Code of Medical Ethics has to say. It's huge, and not written for questions like this, but opinion 2.065 sounds like it might apply:
Physicians can ethically participate in court-initiated medical treatments only if the procedure being mandated is therapeutically efficacious and is therefore undoubtedly not a form of punishment or solely a mechanism of social control.
The forced catheterization was a test, not a treatment, but I wouldn't think that would change the ethical question significantly.
I don't think the warrant changes the situation much either. A judge may be able to force a suspect to submit to an investigative medical procedure, but I'm pretty sure there's case law that a judge can't force an uninvolved third party to perform the procedure.
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I'm surprised that there are physicians who would agree to something like this, although the procedure may not have been performed by a physician. In any case, I hope that this man will file an ethics complaint against any physicians or licensed medical professionals that may have been involved and I hope the local DPR and the relevant ethics board have the courage to treat this as a matter potentially deserving serious disciplinary action.
When I first read this post, I was disturbed by it but couldn't quite place my finger on the reason. I had considered, in writing my post from the legal perspective, the medical ethics aspect of the nurse happily following the officer's directions, but stuck with the aspect that most interested me and about which I was primarily concerned.
After further contemplation, however, I now realize why the medical ethics in your post is so disturbing. It's because it has nothing to do with medical ethics at all, but with the rationalization of medical ethics to intersect with legal needs. There's nothing ethical about the position that physicians can do whatever a court orders. Since when do courts, wholly unconcerned with medical ethics, transcend the ethics of another profession? Why should medical professionals ignore their own profession's ethical precepts to satisfy the demands of law enforcement, legal proof, prosecutorial convenience or efficiency?
Ethics, including medical ethics, is not a mere convenience, to be changed to suit contemporary demands. And yet the AMA has decided that medical professionals have a full panoply of ethical considerations, all of which fly out the window upon the half-baked approval of a judge.
Lucky the judge didn't approve removal of a kidney to be held for evidence.
This isn't just blatantly unethical. It's sickening.
Doc, thanks for your response. It's good to know that medical professionals might see it this way too.
Scott, I'm going to have to think about your comment for a while. The AMA stands up for a lot of principles that don't fit with our justice system---opposition to physician involvement in executions, for example. Why not this one?
As for the comment from the Godless Liberal Homo, sickening about sums it up.
This comment is in response to the post directly above and the related post from 9/11/09.
I think that it's, not test but, an evidence gathering procedure does change the ethical question. I read this situation as effectively turning the nurse into a cop, or the evidence gathering equivalent state actor. For that reason, I don't think informed consent applies here: the nurse was not treating the patient, or even concerned with the patient's well-being, as implied by the ethical opinions referenced in your post here from today (9/11). So I turn to the legal issue, mostly because it's what I'm trained to do (yes slackoise lawyer), and I cannot believe that a catheter is a reasonable seach to prove blood alcohol content. I think a less intrusive, but still unreasonable search/seizure on these facts, would be drawing blood. Still, even a less intrusive means of obtaining the evidence the cop wanted, would not, in my mind, fall under the informed consent doctrine for providing medical treatment.
Perhaps the AMA should come up with another ethics opinion regarding whether medical professionals should ever submit their duty to provide care, and heal, to state law enforcement. I wonder whether executions, while not evidence gathering, is a suitable analogy or more appropriate comparison that treatment and informed consent.