Forced Treatment

Over on the New York Times ’ City Room website , there’s an interesting story about a man who was forced to undergo a rectal examination back in 2003.

Receiving a head injury at a Manhattan construction, he was taken to New York-Presbyterian Hospital and given eight stitches on his scalp. He was, he claims, then told he needed a rectal examination “to determine whether he had a spinal-cord injury. He adamantly objected to the procedure, he said, but was held down as he begged, ‘Please don’t do that.’” He resisted, freed one of his hands, and whacked a doctor—for which, once the treatment was complete, he was arrested, hauled into court in his hospital gown, and “booked on a misdemeanor assault charge.”

The case raises some interesting legal and bioethical questions. It’s hung around in the court system since 2003, primarily because judges have refused the hospital’s many attempts to have the case dismissed as a nuisance suit. As well they ought, for the hospital is caught on the horns of a dilemma: If the staff thought the man was mentally incompetent—too confused from his head injury to understand what he was doing by refusing the examination—then he was mentally incompetent to be accused of battery. But if he was sufficiently in control of himself to be criminally liable for hitting the doctor, then he was sufficiently in control of himself to refuse treatment.

There is another interesting feature, however, for the case fits what has been the media’s narrative for some time now: The great risk in American medicine is that you will be given unwanted medical care—kept alive despite against your wishes, entubed and encased as a vegetable, incapable of pulling the plug.

That narrative was born in the fight for legal euthanasia and physician-assisted suicide, and it has, in the years since, become something like a rogue storyline—a play in search of actors, a narrative hungrily seeking examples. In truth, American medicine these days is much more likely to deny you treatment, resist heroic measures, and pressure you to pull the plug. Newspapers reports such things when they happen, but the events lack the narrative that the opposite medical problem has, and so they never quite rise to the level of national concern.

Curiously, in accounts of treatment abroad—of medical conditions in countries with socialized medicine—the American media has generally been a little more willing to indulge a storyline of scarcity, denial of treatment, and forced exit. But in domestic reports, as far as I can tell, the narrative remains the old, out-of-date tale of compelled treatment and patients forced to medical care.