Why Lawyers Shouldn’t be Allowed to Run a Hospital

Professor Mike Ardagh, from the Christchurch School of Medicine and Health Sciences, spoke yesterday about an ethics study which showed that doctors who save patients’ lives against their wishes could open themselves up to legal action. The study proposed two scenarios – one with a young suicide who wakes from his coma just long enough to asked to be allowed to die, and the other an alcoholic who had fallen and hit his head and refuses to be seen. The results were as expected.

“Doctors and philosophers agreed staff would have been “negligent” not to treat the patients.

“However, both the British and Kiwi lawyers in the study disagreed, saying medical staff had acted “illegally” by assuming patients were “not competent”.

“Patients would be able to “claim damages” if their life was saved against their consent. The New Zealand lawyer said treating someone against their clearly expressed will was “assault”.

“”

Which demonstrates conclusively that lawyers inhabit some sort of parallel dimension (Legal space?) and certainly don’t think like doctors. Lawyers live in a world where you can get multiple expert opinions and read up on a subject before presenting a studied argument in a controlled, orderly fashion. Emergency doctors live in a world where not making an immediate decision is worse than making the wrong one.

I have a rule. When a serious suicide turns up in the ED, I assume they are severely depressed and therefore mentally incompetent. I am well aware that this is not always the case – a 45 year old man with a terminal brain tumour may be making a rational choice to end his life – or he may not. I don’t have the time or the expertise to do a full psychological evaluation. Hence the rule. I am certain my colleagues follow the same rule. 

Only a lawyer would consider saving someone’s life to be assault. I predict that if any lawyer attempted this kind of a charge, he would be unlikely to get a conviction. All that would happen is a sudden explosion of section 21 notices (the section of the mental health act for certifying someone as of unsound mind). This would substantially increase the workload of the mental health crisis team who would then have to pick up every suicide, no matter how trivial, and have them assessed by a psychiatrist. Just what our already stretched mental health service needs.

The other scenario, the alcoholic gent with the head injury is a bit more problematic. Inebriation is not considered to be the same as mental incompetence. The question would be whether his unco-operativeness was the result of alcohol or the head injury. My take is to assume it is the head injury until the CT scan proves otherwise, and most ED physicians agree with me. In general, however, intoxicated blokes are usually fairly easy to calm down and they become quite co-operative at that point. Unlike guys high on “P” who just seem to become progressively “aggro” and need her majesty’s accommodation overnight.

Lawyers would make lousy ED doctors. By the time they had sifted through the data and come to a conclusion, the sick patients would be dead and the department would be a heaving mass of minor ailments. And nobody would ever be discharged – “just in case”. 

On the other hand, ED doctors as lawyers would also be a disaster. It would all be “bugger the logical argument, just give us your verdict and we can all get some sleep”.

Maybe that wouldn’t be so bad…

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