Lines In The Sand

I swear, reading this reminds me of a conversation my buddy has with his three-year-old, right around the time it gets late enough for the kid to get cranky and, more importantly, whiny.  My buddy tells him every time, “Child, when you get whiny, that’s how I know it’s time for you to go to bed.  If you don’t want to go to bed, don’t get whiny in the first place.  Whining about going to bed is only going to get you there faster.”

Course, Little Dude is only three…

tweaker

At least you weren’t scraping them off the front of a Semi… BTDT… (her 4th attempt was finally ‘successful’)

FWIW, I agree that people should have the right to do whatever they want with their life, including end it, as long as it doesn’t affect another person’s freedoms.

The problem with your approach is that society as a whole, and the governments (federal, state, local) in particular disagree.  And once the magic form is signed (5150 here in California, your numbers may vary), the paramedics DO NOT have a choice in the matter.  Since we’re not permitted to place people on involuntary holds, we can not and should not be allowed to clear people from involuntary holds.

Personally, I don’t think that EMS should be involved with involuntary psych holds at all, since EMTs and medics aren’t permitted to place people on holds in the first place.  Too many police officers just fill out the hold form and then “turf” the patient to the ambulance to deal with.  Unless there are clear medical issues involved (OD/toxin ingestion, actual hanging/shooting/stabbing), EMS doesn’t need to be involved.

That’s a very nice philosophy you’ve got there, Sean, but for the fact that other people are involved.
Kill yourself if you want to, but it’s not going to be on a day when I’m civilly liable, with my certification and livelihood at risk for allowing you to accomplish your goal.
So once I’m in the mix, you have lost your right to self-determination until such time as a physician, the courts, or both declare you fit to make your own decisions.
That’s my position, and the laws are on my side.

Kelly Grayson

Well put, A.D.!

There’s gray area and wiggle room, but when the patient herself admits to saying it, or the 911 caller who witnessed the threat is there on scene, I treat it as credible.
In those instances where anonymous third party callers have reported a suicide threat, usually what we do is go with who we find more believable – a lucid, alert and non-distraught patient, or a shadowy 911 caller who refused to even give a name. In those cases, we’re more likely to take the patient’s word.
We’ve also reviewed 911 tapes when the caller wasn’t on the scene, called the 911 caller back, and had them reiterate what they saw/heard specifically.
Kelly Grayson

We don’t place them on the hold. Actually, law enforcement really doesn’t either, but they invariably support our position on the issue.
In Louisiana, the parish coroner (an elected official, and not necessarily a physician) grants broad authority to law enforcement and EMS personnel to transport patients to the ED for a psych evaluation.
It’s called a CEC, or coroner’s emergency certification. They can be issued directly in cases where there is no acute event or immediate threat to the patient or others, or we can act on his behalf if there is credible evidence, by word or deed, of an immediate threat.

Nice sentiment, Sean. Unfortunately there is a lot of legal precedent that puts physicians, nurses, EMS providers and others on the hook if someone says they are going to kill themself, nothing is done, and then the person kills themself.

You can, and should, go check out Rogue Medic’s position on “patient kidnappint”. It will be instructive because he’s just about 100% wrong on the issue.

These are never easy calls. Sure, more often than not they are just BS as the result of some lover’s quarrel. The problem is that there is absolutely no way to know when that’s the case and when the person is full of it and when they really, really, mean it.

The only really reliable indicator is previous suicide attempts. In that case, there is no gray area, but in most of the rest of them, there is.

In an ideal libertarian world, we’d leave people alone. In that same world, we’d be able to do that without fear of liability. I don’t know about you, but I don’t live in that world, I live in the one where people are eager to sue for any error.

You lost me. Want to explain that one?

Louisiana’s system is kind of jacked up. In most states, coroner is not an elected office, but in Louisiana it is.

Here, you don’t even have to be a physician to be elected coroner, but if a non-physician runs against a physician, the physician wins by default. In the parish I used to live in, the local florist was our coroner for years, and he was MUCH better than the physician who took his place.

In the parish I work in now, the director of one of the funeral homes is the parish coroner, and has been for twenty years or more. He does a good enough job that nobody, not even a physician, ever bothers to run against him.

I don’t think psychiatrists are a problem, per se, but our revolving door mental health system is.
Psychiatric care is an essential and legitimate specialty, but sadly, for too many of our mentally ill, what passes for adequate psychiatric care is institutionalization, medication, stabilization, release, and…
… very little follow up outpatient care.

Lather, rinse, repeat.

Complicating matters is that a large portion of our mentally ill have conditions that were caused by, or exacerbated by, substance abuse.
The problem as I see it isn’t that psychiatrists are too blame, only that a) there are too few if them willing to provide comprehensive psychiatric care to the unstable mentally I’ll, and b) consequently too many of them resort to over medication without any real psychiatric services.
Kelly Grayson

This seems like a remarkable – and disgustingly – fascist stance.

You’re not only willing to stand by while someone is imprisoned based on words that he says, you’re willing to actively restrain a free human being who has given zero evidence of intending to harm another and hand them over to other people who will cage them while they are restrained, observed, and given God knows what drugs against their will…all without a court order, a jury of their peers, or any other sort of warrant.

…and you don’t try to justify this through argument.  You just assert it as fact “I will be a willing tool of the State and lock you up, because I’m Just Following Orders”.

I find it hard to understand such a mindset.

> I swear, reading this reminds me of a conversation my buddy has with his three-year-old

The difference, of course, is that three year olds don’t have a full set of God given rights that are codified in the Bill of Rights – adult human beings do.

I fully support a father treating a three year old like an infant.

I do NOT support a State treating an adult like an infant.

 Isn’t holding someone accountable for their words — taking their words seriously — treating them as an adult?

Another point: we had a suicide by semi on the highway here recently.  The semi driver didn’t have a choice about participating.  What about his freedom?

Who the fuck are you to decide that a person should be dragged against their will to gitmo/ fluffy bunny land/ wherever you please? That type of personal violence could and should be resisted in every way available and necessary including lethal force. 

> You made the threat. I don’t get to decide whether it is credible, nor do I want that responsibility. 

Unfortunately, part of being an adult is being responsible for your actions.  You DO have the responsibility to decide whether the orders you’re following are moral, legal, and legitimate. You DO have the responsibility of deciding whether you want to be complicit in caging a free adult and handing him over to a mental hospital.

Being an adult isn’t easy, but saying that “you don’t want the responsibility” while choosing to follow orders is a cop-out.

> paramedics DO NOT have a choice in the matter.  

Sure they do.

We all have free will.

No one is forcing you to put a Jew on a train, or a free person in a psychiatric hospital.

If you do it, be a man about it and admit that you CHOSE to do it and that your paycheck is more important to you than someone else’s freedom.

 Unfortunately, the law disagrees with you.  The state is the owner of your body, life, mind, and spirit(or so the state says).  The state reserves to itself the right to destroy those things.  In other words, you’re morally right and legally wrong.

 Killing yourself: a legitimate exercise of the right of self-ownership.

Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.

     The threatener is initiating force-by-proxy on those with whom he shares his threats.

     Dammit, this isn’t rocket science.

If the call involves threatening to kill yourself, yes you are forfeiting your free will for the next 48-72 hours, but don’t make me the bad guy here.
If you want to kill yourself, I have no intention of interfering with your right to self-determination… unless it involves putting me at risk.
Do it, don’t just talk about it, and don’t get me involved.

Kelly Grayson

 I’m pretty comfortable with this for minors.  Adults have better impulse control, and so it seems a lot less risky to let a Drama Llama say what they want.

 Don’t like the law, change the law- unless you’re just a tough talker, of which we see many.  Advocating lethal force against those bound by said law is irresponsible, stupid, and trollish. 

> Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.

I find the logic whereby one has the right to do a thing, but one does not have the right to mention out loud the plan to do a thing confusing.

And you’ve got a very broad and distorted view of fascism.