Should Physicians Force Patients to be Incarcerated?

The issue of a court ordering patients to submit to care by physicians has been raised in this weeks issue of The New England Journal of Medicine.

In an editorial written by Dr. Julie Cantor, MD JD, she relates the case of Samantha Burton, 25 weeks pregnant when her membranes ruptured, and was admitted to Tallahassee Memorial Hospital and prescribed bed rest for the next three months. When she tried to leave she was physically bared from leaving, and a court ordered that she be forced to submit to the care of the physicians at Tallahassee.

The court heard argument from the hospital-state attorney, and from the obstetrician, who was now considered the “unborn child’s attending physician.” Ms. Burton testified by phone, but did not have an attorney, or an expert, or a physician testifying on her behalf.

The judge ruled that THM and their health care providers could administer any care to preserve the fetus’s life and health, and ordered Burton to comply. Sadly, several days later the doctors delivered a dead fetus by C-section.

If you ever wondered about big brother- this case sums up the issues.

The courts took away this woman’s right to care, and her own body and subjected her to the needs of a fetus. This brings up a simple question- when a patient comes to me for care as a physician, I am the patient’s physician. What ethical obligation do I have to abandon the patient, leave them without a physician, incarcerate them in a hospital, and act as the physician for another entity? The court did not grant this woman, or others, the ability to have their own physician, their own legal council at the administrative hearing – and essentially made them a prisoner without normal sixth amendment rights.

I cannot abandon my patient, but apparently I can if I were an OB-GYN living in Florida, where I could not only instantly abandon the patient but have her brought back to the hospital, even though she is in labor, and require her to undergo a C-section.

The forced intervention of medical care should be unique, rare, and not place the needs of one person against another, or against a fetus. In the article Dr. Cantor brought out that you could open the door that parents should give their kidneys to their children. This is more than a slippery slope – this is an avalanche.

In my opinion the OB-GYN physicians who abandon Ms. Burton should be stripped of their medical license for unethical behavior. Not only did they operate under the veil of court protection thinking they could avoid their own ethics, they operated on her, not to “save the life of the fetus” as the fetus was dead at this point, but for not reason any can see who have reviewed the case.

Forced surgery, forced incarceration is not what modern medical ethics are made of- this is what why we fought Germany and the Nazis.

There are reasons to force incarceration: TB patients who refuse to take their medicine and are endangering the public with infection. Minors, whose parents refuse them care for religious reason (those who have appendicitis and parents might think they could pray that away).

Perspective: Court-Ordered Care — A Complication of Pregnancy to Avoid
Julie D. Cantor, M.D., J.D.
N Engl J Med 2012; 366:2237-2240June 14, 2012

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, then became a renowned weight loss surgeon, and a leading advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he advocates teaching people to improve their health through their food. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcom Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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