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To the Editor, Los Angeles Times                             June 25, 2002
Fred A. Baughman Jr., MD,
Neurology & Child Neurology
1303 Hidden Mountain Drive
El Cajon, CA 92019
Phone: *** *** ****

To the Editor:
Anyone who has given the 4th of July, the Constitution, or democracy, the
least thought, should find the reflections of psychiatrist Elissa Ely in her
essay "How Patients' Right Can Harm Treatment" [LA Times 4/24/02]  chilling.
Patient's rights were not allowed to get in the way of "treatment" in
pre-WW-II Germany.  Consider that your own physician might refer you to Dr.

Ely: "Mr. X needs to start medication, to stabilize and to be discharged
to a setting where his compliance can be monitored."

In every other branch of medicine  we diagnose and treat objective
abnormalities.diseases.  But in psychiatry everything is subjective, in the
eyes of the beholder, and the psychiatrist is the beholder. What exactly, is
"to stabilize" a human being?  What is "a setting where his compliance can
be monitored?"

 Ely: "He also refuses to sign consent forms allowing us to give him any
medication. This means we will need to petition the court to force him to
take anti-psychotic drugs."   "We believed in informed consent,
confidentiality or communication and treatment refusal."  We used to
believe, but no more, is what Ely means.

Non-psychiatric physicians see patients  who eat, smoke and drink to much,
and who fail, otherwise, to comply with treatment plans.  And yet it is not
our duty or place to force prescriptions upon the patient or to report them
as negligent to a court.  And yet this is exactly what Dr. Ely views as
psychiatry's duty.  She concludes:

"It is a contorted world when patients who desperately need treatment can
refuse doctors access to their medical and psychiatric histories."

Who are modern-day psychiatrists that they decide if Mr. X, you, or I, has
"life-threatening delusions" that they "need to treat," that make you an
involuntary patient; that rob you of the free-will they say you can handle
no longer.

In a 1990 editorial "In Bed Together at the Market: Psychiatry and the
Pharmaceutical Industry, psychiatrist-of-conscience, Matthew P Dumont, MD
[Amer. J. Orthopsychiat. 60 (4), October, 1990:484-485] wrote: "The best
this "well-nigh criminal" can do is suggest that the profession give up its
coquettish claims to psychotherapy and social science and openly declare its
identity as an arm of the drug industry."

This is who they are.  They say what they must to make "patients" of you to
"stabilize" with drugs, incarceration, or electro-shock therapy.  This is
their partnership; not with you the patient, but with the drug industry.

Why, does the reader imagine that our informed consent rights such as they
are today, were an outgrowth of the WW-II, Nuremberg Trials.

                                  ### wrote:

Subject: Does _LA Times_ want *you* forcibly drugged?
From: David Oaks - Support Coalition International/MindFreedom 
Date: Tue, 25 Jun 2002 15:49:22 -0700

Once more, the _LA Times_ has published an opinion
piece praising the idea of forcibly administering
psychiatric drugs to more and more people. Feel
free to forward.

The _LA Times_ has been one of the most aggressive
publications in the world promoting forced psychiatric drugging
through their editorials, and through guest column
"op eds" like this.

If you want to e-mail a letter to
the editor of _LA Times_ you
can do so here . Keep your
letter short, include your contact information.


_LA Times_ June 24, 2002
Doctor Files:

How Patients' Rights Can Harm Treatment

   The following is a psychiatrist's bad dream. A
patient arrives at the hospital, committed by a
court after he was found facing oncoming traffic
on a busy road. He has not eaten or slept for
days. He is convinced that a conspiracy is taking
elaborate shape around him and that he is under
attack. He gives his name to the registration
lady as Mr. X. The registration lady shakes her
head and on the admitting form she copies his
real name from the emergency room face sheet.
Next to that, she types: "a.k.a. Mr. X." She has
seen this before.

The necessary treatment is evident. Hospital
staff need to have background information from
those who know him best. Communication between
family, outpatient caregivers and the hospital
must be free and bi-directional. Mr. X needs to
start medication, to stabilize and to be
discharged to a setting where his compliance can
be monitored. The problem is, without his
specific permission, these elements of care
violate his patient rights.

Mr. X refuses to sign his Health Care Proxy, so
there is no one to make medical decisions for him
should he suddenly become too ill to communicate.
He also refuses to sign consent forms allowing us
to give him any medication. This means we will
need to petition the court to force him to take
antipsychotic drugs. This process takes weeks,
during which he will eat only reluctantly and
speak only in fragments. Noncompliance is
standard military protocol, certainly reasonable
for a man "under attack." By holding him in the
hospital against his will, we have proved
ourselves part of the conspiracy. So it is no
surprise--just a soldier's internal
consistency--when he refuses to sign release
forms that would let us contact anyone from his
past for reliable historical details. He won't
even let us tell his family he is here.

Rights are meant to be protective. During medical
training, doctors supported them strongly. We
believed in informed consent, confidentiality of
communication and treatment refusal. We rejected
the grandfather practitioner with his last name
stitched in red across one breast pocket (the
first name was always "Dr."), the one who looked
over half-glasses and mandated this surgery, that
treatment, this medicine. We were tired of a
paternalistic medical model, especially in
psychiatry, where the sicker the patient the
fewer the explanations. We sought collaboration
and choice; our patients would be our colleagues.

Psychiatric patients acquired legal rights of
informed consent and refusal. They can decide
which information to let doctors know, which
medication to take and which treatments to
refuse. They also can defend their decisions in

But because the pendulum is manned by human
beings, it has swung too far. In cases like that
of Mr. X, patient rights have begun to sabotage
treatment. These same rights have lost their
hero's shine and begun to look a little
thuggish--riding into town with six-shooters in
the name of protection, backing caregivers
against the saloon wall, and standing with hands
to the holster, ready to draw at the slightest
opposing movement.

It is a contorted world when patients who
desperately need treatment can refuse doctors
access to their medical and psychiatric
histories. Doctors' licenses can be revoked for
forcing medications on psychotic patients, no
matter how desperately they need them, without
court approval (though perhaps if psychotic
patients were housed in the court until their
cases were heard, the process would move more
rapidly). Treatment can devolve into warehousing.

It just so happens, in this particular
upside-down case, that we know Mr. X. This is his
fourth admission. He consistently stops medication
and falls out of view after discharge. Paranoia on
a grand level becomes only a matter of time.
Probably, the court will let us find out what we
need to know about where he has been since we
last saw him and treat the life-threatening
delusions we need to treat. It has let us do so
before--three times.

But we will need to wait until then. And, if for
some reason the court rules against us, as it has
done in other cases, we are at an impasse. We will
be unable to discharge Mr. X because he cannot
safely care for himself and unable to treat him
fully because his rights have prevented it. It is
a bad dream to have and a worse one to enter.


Elissa Ely is a psychiatrist at a state hospital
in Massachusetts.

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