Ethical decisions are not always unanimous

As a former Yale house officer trained at Yale nearly 50 years ago, I want to congratulate the bioethics program described in the Spring 2004 edition of Yale Medicine [“Two Alternatives, Each a Little Wrong”].

In the case concerning the schizophrenic young man whose mother secretly medicated him, I agree with the attending physician. Although society does not surreptitiously medicate chronic street schizophrenics, in this case a dedicated caregiver (his mother) was available and, on balance, the medication given without the patient’s permission probably contributed to his improvement. Unlike the bioethicist, I would have been willing to cooperate with the mother’s wishes in this treatment of a very major medical disease.

I agree with the bioethicists in the other three cases.

Many thanks for this interesting discussion.

Donald P. Feeney, M.D., HS ’57
Rockford, Ill.

I agree with Dr. Zonana that the physician should not have colluded with the mother who secretly placed medication in the psychotic son’s food, even though the result was marked improvement in the son’s condition. It is also worth asking whether there might have been an advance directive in this case, in which the son, at a time when he was competent, expressed a preference for treatment. Is it possible that he had spoken in the past about the benefits of medication? Might he have even suggested that his mother hide his medicine in his food if he again became psychotic? While these are unlikely possibilities, they highlight the importance of considering the wishes an incompetent patient may have expressed when he was not psychotic. If the son had expressed a preference for medication, the ethical balance between honesty and patient autonomy on the one hand and clinical outcome on the other would have tilted toward treatment. In the legal realm, some jurisdictions are now recognizing health care proxies for psychiatric treatment.

Burns Woodward, M.D. ’71
Waban, Mass.