GESTIÓN EN SALUD PÚBLICA: BioEdge: This is what happens when no one says No to a patient with anorexia nervosa

domingo, 10 de diciembre de 2017

BioEdge: This is what happens when no one says No to a patient with anorexia nervosa

BioEdge: This is what happens when no one says No to a patient with anorexia nervosa

Bioedge

This is what happens when no one says No to a patient with anorexia nervosa

by Michael Cook | 2 Dec 2017 | 1 comment

The death of a young Australian wife and mother raises the question of whether healthcare workers should always comply with the wishes of their patients.

A coronial inquiry is investigating the death in 2014 of a 28-year-old Adelaide woman, Claudia La Bella. It turns out that she was spending A$500 a week on laxatives, sometimes consuming as many as 800 tablets a day.

Mrs La Bella was a complicated woman. Skeletal and weak from the laxatives, she concocted a story for her family and friends that she was suffering from ovarian cancer. She had also embezzled $374,000 from her employer over five years, which no doubt created a great deal of tension.

However, a psychiatrist declared that it was incomprehensible that the staff at a local pharmacy would order 25 to 30 boxes of Dulcolax for her every week, each containing 200 laxative tablets.

"I still cannot comprehend how they morally and ethically sold someone up to $500 a week worth of laxatives," Dr Maria Naso said. "Just because they are not a regulated item does not mean we can forfeit our moral and ethical responsibility."

“Most people know that laxatives are abused by teenagers — girls talk about it in school, it’s on the internet. Selling that amount is beyond words,” she told the coroner.

Dr Naso said that a letter should have been requested from the woman's doctor. "It is hard to not see this as a purely financial transaction that was of benefit to the owner," she said.

Reluctance to deny patient demands also emerged when she was admitted to hospital, weighing only 35 kilos. A CT scan showed dozens of tablets in her stomach. Nonetheless, she decided to leave the hospital nine days before her death. The doctor in charge advised against it but was reluctant to press the issue because she did not appear to have a mental illness.

The psychiatrist questioned the doctor’s judgement. "She was willing to place herself at risk and leave her daughter potentially motherless — this itself should have raised grave concerns for her mental state." Other doctors had raised the possibility of anorexia nervosa. The doctor could have legally required her to remain in hospital for 24 hours in order to get a psychiatric assessment.

It appears that too many people, including her family, said Yes to Mrs La Bella. Now she is dead.

Unlike issues such as euthanasia or stem cell research, the bioethics of tattoos is not highly developed. However, it presents its own challenges and complexities. What if a patient shows up in emergency with "do not resuscitate" tatooed across his chest? Is that a valid advance end-of-life directive? There are so many issues here. How do the doctors know if he (let's assume it's a "he") still wants a DNR? Did he get it when he was drunk? Was it voluntary? There are so many fascinating issues -- read our preliminary report below.

On a completely different note, with Christmas drawing near, I’m making an incredibly self-interested suggestion. Why not put a copy of my recent book, The Great Human Dignity Heist: how bioethicists are trashing the foundations of Western Civilization, in someone’s stocking? It’s available through the Australian publisher, at Amazon and at Book Depository. I can’t think of a better gift!