Dike, C. C. (2024).
Psychiatric News, 59(07).
An inpatient psychiatrist and her team are caught in a quandary. A hospitalized patient with chronic respiratory compromise is demanding to receive a COVID vaccination, but his conservator of person, also known as adult guardian in some states, is refusing to consent to the vaccination. Staff members suspect that the conservator’s refusal to approve the vaccination was driven by the conservator’s religious and spiritual beliefs. They also believe the patient’s best interest will be better served by getting the vaccination, given the patient’s underlying serious medical condition.
A different scenario is playing out in a sister hospital. A medically compromised patient admitted for psychiatric treatment is refusing the recommended COVID vaccination, but her conservator is insisting the psychiatrist should proceed with the injection, including holding or strapping down the patient to administer it. The psychiatrist is reluctant to do so over the patient’s objection but is worried about disregarding the request of the patient’s conservator.
Examples such as these—in which conserved patients’ requests are disapproved by their conservator—are common in psychiatric practice. Areas of conflicts include refusal to provide funds for cigarettes, certain food items, phones or computers, and alcoholic beverages and decisions regarding where to live. Often, the treating psychiatrist is caught in the middle.
Here are some thoughts:
This article wrestles with the ethical tightrope mental health professionals walk when treating patients with conservators. Balancing patient autonomy and their best interests is complex. While conservators are meant to protect those unable to care for themselves, the system can infringe on patient choice. The article emphasizes respecting patients' wishes whenever possible, and that mental health professionals must be vigilant for potential conservator abuse. Ultimately, mental health professionals must act as patient advocates, focusing on their well-being (and in court if necessary). Even when court decisions go against the patient's wishes, the mental health professional's ethical duty remains - to support the patient through the situation (aka patient autonomy).
