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And I thank you for your disagreement. Thanks for playing brother. These threads tend to die quickly when a halfway coherent contrary opinion is posted, and that's too bad. But see, this is where I believe that we split the sheets. From my personal experience I can tell you that though I've run on skads of 'attempted suicides', I'm confident that I've never truly run on one where the intent was death instead of attention. Scratches across the wrist, drinking a quart of tequila 'to end it all', taking a few of moms Viccodin, does not to me constitute and aggressive, honest attempt to take ones life. Are these cries for help? Sure, I believe that they are in many cases, simply grande standing in others. But either way I don't believe that it constitutes signs and symptoms of a person that has become acutely altered beyond the point of self advocation. As above. I would argue here that the person refusing care from a trauma or acute onset pathology is much less able to advocate for themselves due to the emotional, physiological changes that take place along with such an event. If we're going to force anyone against their will, and I know that that line is very fuzzy, it should be these folks, not the coherent 'suicide' attempt. Now, I'm not exactly sure how to make my point while also making it clear that I'm not advocating, 'There's no need to transport 100 bullshit pretend suicides just to save the one person actually in danger!' My argument hinges not on the amount of work involved, but on the rights of those people that are able, to the best of our ability to detect such a thing, to advocate for themselves. I agree completely. But I would again state that it is my belief that the vast majority of my 'suicide' attempts were lucid, without an acute event causing the behavior. I know I'm going to take a beating on this, and I look forward to it, but with the information that I have now, that is my belief. Again, completely agreed. And in a perfect world we would have a, hell, I don't know, one of those StarTrek thingies that would allow us to discover such things. But as it stands now, most of our protocols, and I believe the law, only allows us to force transport when that type of pathology is identifiable by us. In some cases they will be, but I don't believe that that appears to be the case in the OP. Again, certainly agreed. And in a perfect world I would again be able to treat this pt against their will. But if I see the s/s of hypoglycemia, yet the pt refuses to allow me to test and treat for it, then I am unable to develop the evidence necessary for me to treat this pt against their will. I will want to, and will exhaust every trick and trap at my disposal to do so, but if the pt is still mentating at the level that you mention, then I have no legal right to treat them. Though I know that they are physiologically altered, and I believe that that altered state is causing them to make poor decisions, unless the police decide to step in, then I have no legal right to treat this pt. I'm going to hope that you were simply making your point and that I haven't presented my arguments so poorly that it's believed that I feel that AAOx4 is adequate information for the judging of reliable mental capacity. Unfortunately, in most cases it will be adequate for the necessary legal capacity to refuse. I've only two or three times had someone that I've truly wanted to transport refuse. One one of those I involved law enforcement and have regretted it every day since. An older woman with a hugely swollen leg secondary to cellulitis. She refused to take her antibiotics because they made her sick to her stomach. Her PCP had been consulted about this but she didn't like her options. Circulation was compromised distal to her knee and I knew that she was going to die from this infection if left untreated. She had multisystem issues, was tired, hated the hospital and truly believed that resting would cure her, and if not, then she was ready to die. I forced her to go despite, in my opinion, her being very capable of understanding her predicament, including the high risk of death, and accepted them. I involved the police, who refused to intervene, then I involved Social Services who declared her unfit to care for herself, giving me the right to force her to the hospital. To this day I believe that that is THE most morally/ethically bankrupt thing I've done as a medic. Is my decision going to be popular here? Sure. Would that be a feel good story to tell at parties? You bet. But I took away the rights of an old woman, mentating perfectly to every way that I could find to test her, except that she made a decision that I disagreed with, and forced her from her home so that she could die in a place that she hated. And we should all call bullshit on that. But again, I pose the question. If a clinically obscure mental alteration is all that is necessary to force transport, then aren't we then obligated to force the obese, the tobacco user, the chronic alcoholic? Each of these as well has been well proved I believe to involve mental/physiological aspects that are beyond the individuals ability to control with the available tools in their current toolbox. The only difference I see between them and the attempted suicide is the timeframe. One is simply going to die sooner than the other, but all will ultimately die secondary to their pathologies, right? Do they all then lose the right to refuse? Thanks for you post man. I look forward to your thoughts. Dwayne

Dwayne, I'm going to disagree with you on a few things. Your case with the elderly woman doesn't exactly fit here. There's a big difference between someone who is refusing care, even if it brings additional harm to them self by lack of action and actively seeking to harm them self. Actively attempting suicide, as a rule (exception being physician assisted suicide), is a sign of acute psychiatric illness which precludes the patient understanding the true consequences of their actions (I'll get back to capacity in a minute). Suffering an injury and then refusing treatment is not the same since the patient did not want the injury as a part of a disease process. What this all comes down to is capacity to make decisions. Capacity is important because being able to answer who/where/when/why doesn't really indicate capacity. It indicates that you know where you are, who you are, when it is, and why you're there. If a disease process makes it so that a patient can't properly make decisions, then it doesn't matter. A patient who has major depression with psychotic features where the voices are telling them to commit suicide lacks capacity even if they're A/Ox4 because the disease process itself makes it so that the patient can't make decisions. I'll give a non-psychiatric example. A patient who is hypoglycemic to the point that they begin to lose mental function loses the ability to refuse medical care until the hypoglycemia is corrected. Even if they are A/Ox4. Why? Because the disease process is affecting their ability to make decisions and you don't know if they're refusing care because they don't want help for legitimate reasons or because of the disease process itself. Now, sure, amp of D50 later, "Thanks guys, I'm gonna go fix myself a sandwich, where do I sign?" is fine because the acute disease process affecting their ability to make decisions has been reversed. To take the concept of A/Ox4=everything's peachy to the extreme, then there should be no any such thing as involuntary committal.

Here in the States, as soon as you're arrested, you've got a 'criminal record' for life. With the court imposing punishment, it's the same as a conviction. She was wrong, she admitted to being wrong and ultimately was handed a punishment for her actions. I disagree with the courts for reducing the sentence in any fashion. All that does is send the message that if you're a 'basically good kid' and you break the law, you shouldn't have to spend any time in jail.

We are not here to merely make a living. We are here to enrich the world, and we impoverish ourselves if we forget this errand. ~ Woodrow Wilson To start out with, I have no clue if this is a quote by Woodrow Wilson, and I frankly do not care. The content of the quote is what should be discussed. The quote gives a reason for existence, to enrich the world. In my meek world, I question quotes like this, but more importantly, the meaning of existence. So, the question to be discussed, what is the purpose or meaning of our existence? This thread is purely an exercise of mental masturbation. I think it would be an interesting discussion topic. I hope others concur. To start off with, I want to say this without stepping on everyones toes. One answer I do not accept personally for this question is the religious view. This is not to stop those who are religious from joining in on the conversation, but, I ask that we do not simply say in so many words 'we exist for God'. Follow the religious answers up with something of great sustenance. I am willing to explore the area of religion as it applies to this discussion, but, I hope too many do not get pissed off with where it may go. See what I am saying? Matt.

Whether it happened or not, my answers remain the same. It really doesn't matter what your personal feelings are. You're not Judge, Jury or Executioner. Your personal feelings should NEVER dictate what type or level of care you will provide. You don't get to 'let them suffer' because you don't like what they did. Your ONLY concern is to render the appropriate care to the best of your ability. You call a staement like being respectful? I call it antagonistic, and any 'tongue lashing' you got from a patient in pain was well deserved. Additionally, any crew member that engaged in this type of behavior would be facing disciplinary actions. What do you suggest that the company do; remove the truck from service and make one less crew available to help the public? If the crew wanted the rest of the night off, it's understandable. If they wanted to stay on shift, that's their choice. As a supervisor, I would make the option available, and support the crew in whatever choice they made.