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Ethics question (1 Viewer)

bostonfred

bostonfred

Footballguy
Some of you know my brother is mentally ill. He's been through some difficult times - psychosis, schizophrenia, homelessness,  ptsd.  While he was homeless, a police dog came after him and he hid in a shed, then when it came in after him he hit it with a shovel. In case you're wondering, that's not considered self defense, that's assault on a police officer with a deadly weapon. They tasered him enough that he bled through the seat of his pants, sent him to jail, and then when he got out, they tasered him again when they found him outdoors and homeless. I'm sure he didn't help matters for himself, but it was a vicious cycle. 

I was able to get him out of that situation, but he went back into the system and I was unable to even find him for about a year.  He has a court appointed guardian which was necessary because he was refusing his medication, both for mental health and physical health.  They put him in a rest home far away from anyone he knows. As you might imagine, he has developed a great fear of authority, including doctors and court orders. 

Now he's in the hospital, and he's got internal bleeding of his colon and a bad infection, and is in need of surgery.  

He's refusing the surgery.  

He's apparently lucid enough to answer their questions, and the hospital is having an emergency ethics review of his case to determine if they should do the surgery against his wishes to save his life.

They want me to attend. 

I hadn't talked to my brother in a year, and when I finally did he also told me that he didn't want the surgery and that he was scared and didn't think he could handle it. This isn't just surgery, either - he will probably need a colostomy bag for quite a while, so he will constantly be reminded of it if they do the surgery and he will never know if the surgery technically saved his life or not. But he will know that he was forced to wear a #### bag because of it.

The ethics review is happening soon.  Any thoughts and advice appreciated. 

 
If the alternative to the surgery is death then doesn't it make sense to have it?  Seems pretty black and white here unless I am missing something...

 
It's certainly high risk not to have the surgery.  I don't know if it is 100% certainty of death, but if so the then my vote would clearly be yes

 
Ugh.. I'm so sorry for this. I want to say I can't believe that the system has treated him like that... but sadly having had a buddy in it, I'm not surprised. 

I don't really have any answers here other than try to spend some time with your brother beforehand... try to get a feel for the basis for his objection. 

• IF he's objecting because he doesn't trust them... try to assuage those fears. 
• IF he's objecting because he no longer wants to live... try to comfort him and see if you can give him a reason to change his mind. 

Very tough situation. I am close to my brother and can't fathom your position. Good luck either way buddy. I hope you find peace in whatever path this takes. 

 
damn- so sorry to hear about all of this, fred- I didn't know.

is there any way of getting him on his meds first- so he's at least of better mind to address this? the people I've known who were diagnosed schizophrenics flat out needed to be on their meds or their worlds disintegrated.

I can't imagine what you're going through- and have gone through.... I feel for you and brother- all the best to you both.

 
bostonfred said:
It's certainly high risk not to have the surgery.  I don't know if it is 100% certainty of death, but if so the then my vote would clearly be yes
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Sorry about your situation. I think you have to be the "voice of reason" for your brother if he is incapable of being one on his own. It's not easy to ignore his wishes, but I think you have to do it for his own good. If he gets back on his meds and "normalizes" a bit, he'll thank you for it. 

 
[icon] said:
Ugh.. I'm so sorry for this. I want to say I can't believe that the system has treated him like that... but sadly having had a buddy in it, I'm not surprised. 

I don't really have any answers here other than try to spend some time with your brother beforehand... try to get a feel for the basis for his objection. 

• IF he's objecting because he doesn't trust them... try to assuage those fears. 
• IF he's objecting because he no longer wants to live... try to comfort him and see if you can give him a reason to change his mind. 

Very tough situation. I am close to my brother and can't fathom your position. Good luck either way buddy. I hope you find peace in whatever path this takes. 
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Wow BF, I'm really sorry your brother, you, and your family are going through this.  I can't imagine what that must be like, but I know you're a strong dude.  He's lucky to have you in his corner.

[icon] said what I was thinking also, so just echo'ing his post above.

I'm sorry I don't remember, but are your parents around/involved?  What do they have to say?

 
Your brother got the short end of the stick and has been mistreated by those he should be able to trust.  That being said, he is not in a position to make sound decisions and needs someone he can trust to make them for him--even if he disagrees at the time.  It's much easier to type than apply, but do what you think is right for him and if it involves surgery, help him get back to health after.

 
Man, I have no advice. Just prayers.  

This is a no-win situation anyway you look at it. If he doesn't have the surgery, he potentially dies. If he has the surgery, is he mentally capable of handling the aftermath. 
 

 
I am sorry to hear about this. Bad spot to be in. You will have guilt and second guess whichever way you go. Mental illness is so tough and often is a never ending cycle. 

If i were in your shoes, i would let him decide. 

Good luck to you either direction you choose. You are a pretty thoughtful dude and i am sure it will have been given the weight it deserved and hopefully you can be ok with it. 

 
Ned said:
I'm sorry I don't remember, but are your parents around/involved?  What do they have to say?
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My mom has also had mental health issues and she is more the type to pray on it than to take any action.  

My dad doesn't know I found him.  They're estranged (my brother's choice) and my dad has been dealing with blood cancer and heart issues and just got done with his own high risk surgery.  His wife (wife number 3 so I dont really know what to call her) and i decided it was best not to talk to him about it. 

Also I'm here to make everyone feel better about their families today. 

 
mr. furley said:
can you have him involuntarily committed?

have you been able to discuss possibly being made his guardian?
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The hospital can't force him to have surgery without an ethics board review. That's happening today.  

He's already been "committed" to a mental health wing of some kind of rest home, which is why I couldn't find him. Hipaa.

 
bostonfred said:
The hospital can't force him to have surgery without an ethics board review. That's happening today.  

He's already been "committed" to a mental health wing of some kind of rest home, which is why I couldn't find him. Hipaa.
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is he on his meds? 

any idea what's causing the bleeding colon? is it related to the tasering incident(s)? 

 
El Floppo said:
is he on his meds? 

any idea what's causing the bleeding colon? is it related to the tasering incident(s)? 
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Don't know.  He's not in great health. Those places pretty much offer 3 types of entertainment, eating, cigarettes, and a common room with other mentally ill people.  

 
I was able to talk to him on the phone.  He's scared, and he's worried that God might not want him to have someone cut open his body.  

He also said he's told them no so far but that he can always change his mind. I think he's waiting hoping that this all just goes away, which it won't, and waiting sounds like a very dangerous thing to do. 

I asked him if he wanted me to come down with my mom to be with him, but i didn't want to push if he didn't want company.  He was mad at me at one point and I think he still is. I told him I loved him and he said he was tired.  

This sucks.

 
thayman said:
Is there any way you can get him out of there and into a better facility?
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 If he didn't have the current health issue, I'd certainly have tried.  But there aren't a lot of options for someone with mental health issues and he's going to need help to care for a colostomy bag. When he's lived on his own, he's made bad decisions.  I don't think I can bring him to my house, that wouldn't be remotely fair to my wife and I don't know how it would impact my kid. It's just a brutal situation. 

 
bostonfred said:
 If he didn't have the current health issue, I'd certainly have tried.  But there aren't a lot of options for someone with mental health issues and he's going to need help to care for a colostomy bag. When he's lived on his own, he's made bad decisions.  I don't think I can bring him to my house, that wouldn't be remotely fair to my wife and I don't know how it would impact my kid. It's just a brutal situation. 
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Sorry this is happening to you and yours.  Really tough, best of luck again.

 
I'm sorry you and the family are going through this.

If your end goal is to convince him to have the surgery, I would work on the God angle. No idea where you stand as far as God, but he clearly cares. I would try to convince him that God put doctors in our lives to take care of things like this. Its no different than fixing a broken leg or delivering a baby. Doctors are here to help.

 
bostonfred said:
 If he didn't have the current health issue, I'd certainly have tried.  But there aren't a lot of options for someone with mental health issues and he's going to need help to care for a colostomy bag. When he's lived on his own, he's made bad decisions.  I don't think I can bring him to my house, that wouldn't be remotely fair to my wife and I don't know how it would impact my kid. It's just a brutal situation. 
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an unmedicated schizophrenic with a colostomy bag is sepsis waiting to happen and that's probably worse than what he's currently going thru.

floppo's right - being sure he's medicated long & well enough to decide for himself, then honoring the decision is the way i'd go with this

offer the best you have, fred, not the most you have. we all owe that to love & family, but it's ok to stop there. GL - 

 
Sorry to hear the situation Fred. In the end, I'd say go with your heart on what you think is the best for him. It may be a no win situation, but you can at least try to do the best for him you can. I think reaching out to him like that was the right thing.

 
Fred:

     As someone who went through something similar with my FIL  and he ended up in a hospital luckily for us. I would attend and get him the surgery.  Even if he is "lucid" as you say if he truly has mental problems he may be thinking "ok" at the time of the questioning but not really thinking the whole thing through and can't.

Just my .02

Good luck - its a tough deal 

eta: there are facilities that can handle mental health and physical at the same time - but a) they are limited b) they aren't always willing to take some one right away

 
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With his officiated psychiatric history, you have to trust that the ethics board will use the proper resources to make the right decision. Very hard to say without knowing more details.

Very sorry to hear as it's just an awful situation overall. Very best to you and him and your family. Keep us updated.

 
bostonfred said:
I was able to talk to him on the phone.  He's scared, and he's worried that God might not want him to have someone cut open his body.  

He also said he's told them no so far but that he can always change his mind. I think he's waiting hoping that this all just goes away, which it won't, and waiting sounds like a very dangerous thing to do. 

I asked him if he wanted me to come down with my mom to be with him, but i didn't want to push if he didn't want company.  He was mad at me at one point and I think he still is. I told him I loved him and he said he was tired.  

This sucks.
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I have an Aunt who is mentally unstable, it's hard to get through to her, she usually looks at me and says "you look ornery" in the middle of any serious conversation.  My Uncle (her husband) was a saint, he did EVERYTHING for her for years now.  Unfortunately, he just passed away, she's totaled 3 cars in 3 days - hers plus two rentals - she had her license suspended, she won't take the bus (because crazy people ride the bus - her words) - so my Sister (God love her) - has been taking her everywhere.  So, knowing from a distance what you're dealing with and I'm not being a smarta$$, I would do the following :

1.) Get another opinion if at all possible, maybe someone that's a specialist.

2.) I would tell your brother you had a dream and that in your dream you spoke to God yourself and God said it was okay for the right Doctor to cut open his body.  You tell him you are working with God on this and when you find the right Doctor, God will let you know.  You tell him God will be with that surgeon and that, per your conversation, God insists that your brother get this taken care of immediately.  

That's all I got, good luck and God bless you BostonFred.

 
I might be in the minority here, and I don't want to come off like an unfeeling **** here, but do they have a post surgery plan for him?  Like someone said above, if he has mental issues and is refusing to take his meds a colostomy bag seems like a setup for disaster if he doesn't have the support that is necessary.  That seems like it would be an awful way to live and die.

Very sorry this is happening BFred. :(

 
Given the timing of the OP, you've probably already made your decision and the review has already happened.  My only advice, bf, is to follow your conscience.  You need to do what you think is right, even if that means (a) your brother becomes angry and never forgives you or (b) your brother does not get the help he needs because you are following his wishes.  Either way, the important thing is to do what you think is right.  If you do that, you will be able to live with the consequences.

If you need more time to ask the right questions so that you can be comfortable with that decision, ask for it.

Thoprawishes and good luck. Tough spot to be in gb.

 
I wish I had some great insight for you, but unfortunately I do not.  I just want to wish you well as you work through this difficult situation.  

 
Im really sorry you're going through this, bfred. And sorry for your brother.

I've been involved in similar cases at work. I'm a huge proponent of allowing people to determine their own fate, but this situation is just such a subtle gray area. It's an agonizing decision as a professional, even with the detachment that affords. I can only imagine how difficult it is to feel like you're making the right decision when it involves someone you love, but are estranged from because of your/their mental health issues and history.

What are your thoughts? What are the issues involved that you are struggling with the most? 

 
Foosball God said:
I might be in the minority here, and I don't want to come off like an unfeeling **** here, but do they have a post surgery plan for him?  Like someone said above, if he has mental issues and is refusing to take his meds a colostomy bag seems like a setup for disaster if he doesn't have the support that is necessary.  That seems like it would be an awful way to live and die.

Very sorry this is happening BFred. :(
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You aren't alone here.  My FIL died after more than three months in the hospital.  It's not fun to watch.  You really need to get a feel for how likely it is that he will die anyway.  Pain and suffering are definitely factors.

I am so sorry you are going through this.  It really is the big suck.

 
Thanks to everyone for chiming in with advice and or encouragement.  Quick update, he's told them that he's afraid of how God will feel about it. And it sounds like the hospital is now obligated to treat it as refusal for religious reasons, which apparently means no surgery for now.  And he's not answering the phone anymore when I call. #### a duck. 

 
:(   blood, man. 

is he close enough to see in person to get a better sense of wtf is going on with him (physically and mentally)

 
I just talked to his surgeon.  Good guy. Took a lot of time to talk to me.  Gave me his personal cell. Really trying to do the right thing. 

They've gotten the green light to operate on him from his guardian and the ethics board. 

They still don't have the green light from him though.  Which is a logistical nightmare. If you wheel him down the hall to surgery against his will... bad.  If you knock him out and don't tell him you're operating on him until he wakes up, what happens if there are complications.  If you tell him and then try to sedate him, that's scary AF.

So my job is going to be to go down there and convince him to do this, without seeming like I'm the guy that made it happen,  which I'm not, but he'll immediately think that because I show up and tell him he should have surgery and next thing you know he's having surgery.  And somewhere in there I'm supposed to see my brother for the first time in a long long time and maybe the last time if there are complications. 

And to make matters worse I don't know if I'll be able to think about any of this without worrying about being in the room with his antibiotic resistant poop infection, and whether I'm bringing something nasty home to my family from a small town hospital.   And that  might sound selfish but it can't not be in my head. 

I think I'm going to Wal-Mart, get a cheap tablet and load it with stuff i know he'd like, get some cheap sweatpants and a long sleeve t shirt I wouldn't mind throwing out and wear them one time then throw them in the hospital trash and walk out naked.

 
Frankly, given what you've said so far, I have confidence that you will do the right thing, even if it doesn't seem like it at the time.

Good luck.

 
Obviously, it's a very hard thing you're facing, Fred.  I'll be thinking about you and your brother in the coming weeks.  I'm sure you'll approach the process thoughtfully and purposefully.  Good luck.

Matt

 
If you are not the guardian what is the purpose of the Hospital wanting you to attend.  Is it that they want to establish a record and obtain cover for the decision they know they are going to make?  Is this a prophylactic measure against future lawsuits?

 
Just catching up on all this.  So sorry to hear, fred ...just a no-win situation all the way around.  This is a burden you didn't ask for.  Stay strong and be patient.

 
good luck, fred.  With respect to the surgery, I think you are really ok with leaving it in the hands of the ethics board.

The best thing is to give your brother love and attention, in a way that you won't have later regrets.  Do that, and you hopefully will find peace with your decisions. 

 
Headed down today.  Several hours of driving and I don't even know if he'll want to see me or if he's even able to talk to me really. I've loaded up a tablet with Netflix and created a list for him plus added some downloads and written some instructions for how to do everything.  Wish me luck.

Thanks for the support in this thread and in the sci-fi fantasy thread. Appreciate

 
bostonfred said:
Headed down today.  Several hours of driving and I don't even know if he'll want to see me or if he's even able to talk to me really. I've loaded up a tablet with Netflix and created a list for him plus added some downloads and written some instructions for how to do everything.  Wish me luck.

Thanks for the support in this thread and in the sci-fi fantasy thread. Appreciate
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Best of luck, Fred. Thoughts with you and your brother this weekend.

 
Best wishes Bfred.  I guess the only thing I could say is that although he may not be full in control over his mental state, you should extend to him however much control he desires to have over his decisions.  If any decision making control is removed from him he may be even more upset, which I'm sure is not what you want.  I hope your brother finds peace.

 
Your brother needs the surgery, period. Once that's done, go from there.

Tough situation. I've been through this with a family member & it's a rather difficult thing to navigate.

Best of luck, my friend.

 
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