Duty of 'Care': Is it Ethical? by Anna de Jonge

A paper presented by Anna de Jonge, a MindFreedom sponsor group leader in New Zealand, about psychiatric human rights violations.

Women’s Studies Conference Paper
Presented: 26 November, 2005 at Auckland University
Title of the Paper: Duty of “Care” is it Ethical?
Presented by Anna de Jonge
Members of Patients’ Rights Advocacy
65 Tawa Street
Hamilton 2001
New Zealand
Ph:Fax:+64 7 8435837
email:<rens.dej@clear.net.nz>

The Continuing Critical Debate

Issues, Patients Rights Advocacy are amongst the very few organizations in
New Zealand which are openly protesting against Electro Convulsive Shock
Torture. We are giving this issue as much publicity as possible. Those
given Electro Convulsive Shock ‘T” should be seen as victims of torture by
the state. It starts with classifying, devaluing women with labels. Electro
Shock, a violation of Human Rights and barbaric a practice, is going on in
almost every hospital in New Zealand.

We challenge the forced psychiatric drugging and Electro Convulsive Shock
‘T’ Torture, which is harmful, degrading and inhumane. Despite denials by
the Psychiatric Association, the scientific fact is that: Electro Convulsive
Shock always causes brain damage, including memory loss.

Forced psychiatric drugging in hospital and under Community Treatment Order,
(C.T.O.) as an outpatient in one’s own home under the legislation, is
against clause 10, of the New Zealand Bill of Rights.

Devaluing, in all its myriad forms, remains a serious issue in the lives of
many women, despite increased awareness of its prevalence and impact over
the last 35 years. This special issue of my paper will feature a diverse
range of perspectives aimed at increasing our understanding of this social
phenomenon.

There are different forms of devaluing effects on women: physical,
emotional, psychological, and economic. Your partner and doctor can
instigate it, but the legislation, intervention and support service support
the hidden evil. We are particularly interested in exploring this issue in
relation to the experiences of rural and immigrant women and we also
welcome examples related to women’s experiences even as perpetrators of
devaluing.

Talking to the doctor can result in being culturally misunderstood,
stigmatized and mistakenly labeled. The terms invented by the American
Psychiatric Association were published in 1952 with 60 types of disturbances
they decided what they consider “normal” and are reflected in the prejudices
and values of each generation. It’s not surprising that the Diagnostic
Statistical Manual, DSM 1V expanded further and has become a battleground.
DSM 1V, diagnoses are voted on, new words and labels invented, there seems
to be endless ways to identify people. None of these misuses will be
discovered or challenged by the patient, such as being wrongly diagnosed and
therefore prescribed harmful drugs and forced ECT. As soon as a
professional makes a classification following the D.S.M. 1V, the rest of
society, the judge, the law and Accident Rehabilitation Insurance
Compensation believe and act on it.

The fact of this person being labeled, results in being drugged with
Neuroleptic drugs and there after deprived of humanity, never being treated
as normal again by the medical establishment.

Example: the Authorities take over as soon as they have a chance. They call
it assessment and treatment. As soon as a patient enters the doctor’s room
or the hospital, she is under the doctor. Patients Rights does not seem to
apply.

If a patient refuses “treatment” drugs and ECT, the doctor can put her
under the Law, the Mental Health Act 1992, which comes from the Lunatic Act
1400 English Law.

When a patient refuses “treatment”, the doctor gets a second opinion, even
if the doctor giving the second opinion has no right to do so! The patient
is shocked under force. No one is protecting the patient. It is all done
behind closed doors. The rights fly out the window.

A case of negligence. “The System” is set up to fail the patient. Ask the
psychiatrist why they are giving Electro Convulsive Shock to women?

After the patient is damaged, they can claim for Medical Misadventure under
the ACC Act. If the Medical Misadventure unit in Wellington, declines the
case for cover, the patient has the right to ask for a Review.

The patient is totally unaware what they have written in her file. When she
discovers the lies written in the medical file, she is shocked to the core.
She can ask to have false misleading information corrected, under rule 7 of
the Privacy Act.

This is problematic because by now, everyone in the system has been given a
copy of false misleading information. After 2 years we go to Review. The
Reviewer accepts or declines her case. If accepted, entitlement can be
requested.

Before entitlements are considered the patient is requested by ACC, to be
assessed by a psychiatrist, a colleague of the perpetrator. When he decides
the patient is not damaged. The reason given: ECT is in his view a
lifesaving “treatment” even when we can prove that a crime has been
committed!

He can be as nasty as he can be, but ACC has no jurisdiction over the
doctor.

We ask for a review, under the ACC code. The Reviewer can only see if they
did everything following the rules, according the guidelines. We can ask the
Health and Disability Commissioner (HDC) to investigate. The HDC ask the
authorities. Even when the investigation is flawed, no one takes
responsibility, no one looks at the outcome, no one is held accountable.

Recommended reading:
Deprived of Our Humanity The Case Against Neuroleptic Drugs by Dr Lars
Martensson, 224 pages. Survivors and physicians make the case against the
terrible physical and psychological toxicities that accrue from Neuroleptic
drug use. Nearly all universal psychiatric practices are called into
question and attention is focused on the cruel experiences of millions of
victims.

A collection of essays discusses what organized psychiatry, the
pharmaceutical industry, the government and the academic community have been
eerily silent on: the problems with the pervasive use of Neuroleptic drugs.
Order from: The Voiceless Movement PO BOX 235, 1211 GENEVA 17,
Switzerland.
Editor Association Ecrivains, Poetes & Cie 23 a Ave Dumas PO BOX 2142, 1211
GENEVE 2, Switzerland I.S.B.N. 2-88462-039-0-7

Professor Sachdev has written a book describing acute, chronic and sub
acute akathisia, restless legs, which is an everyday occurrence on this
ward. Professor Sachdev also suggests how such problems might be avoided:
by informed and ethical practice.

See: Perminder Sachdev: Akathisia Restless Legs Cambridge University Press,
1996.

I quote: Ethical and legal issues

Because Drug Induced Akathisia (DIA) is an iatrogenic, doctors induced
disorder, which leads to serious distress, may compromise the psychiatric
status of the patient, may lead to impulsive actions (aggression or self
harm) and may become chronic and resistant to treatment, it is of much
ethical concern and may lead to litigation.

The most common allegations against psychiatrists, in reference to
medication side-effects, pertain to two areas: negligence and informed
consent (Lawson, 1989).

A negligence or ‘tort’ action is successful if the plaintiff can establish
by a preponderance of evidence (i.e., more convincingly than the contrary
can be established by the defendant) that the psychiatrist violated his or
her duty to care for the patient (by an act of omission or commission),
leading to physical or emotional injury to the patient.

In the case of akathisia, an appropriate standard of care will involve:
(i) performing a detailed assessment of the patient to establish the
diagnosis that indicates treatment with a neuroleptic or other
akathisia-inducing medication;

(ii) considering suitable alternatives to the prescription of such
medication;

(iii) prescribing the drug in the appropriate dosage, and for the proper
duration, as is generally considered by the majority of the profession;

(iv) recognizing the side-effect early, alerting the patient to it and
taking the appropriate measures, which include reviewing the offending
medication and monitoring and treating the akathisia when indicated;

(v) recognizing the risk of Tardive Akathisia (TA) restlessness, fidgety
movements or swinging of the legs while seated, rocking from foot to foot or
‘walking on the spot’ while standing, pacing to relieve the restlessness ,
or an inability to sit or stand still for at least several minutes and
Withdrawal Akathisia (WA), and using generally recommended practices for
long-term treatment, while being cognizant of the attendant risks;

(vi) consulting with psychiatrist colleagues and, if necessary, experts in
the field, in case of doubt.

This protocol is only courteous common sense in prescribing any medication
or treatment as every treatment has an attendant risk.
I submit that his protocol would be an appropriate standard of care for the
Health Department to endorse.

Reference:

Martensson Lars M.D. (1998) Deprived of Our Humanity by The Voiceless
Movement, Switzerland.

Perminder Sachdev, (1996) (Professor) Akathisia and Restless legs, Drug
Induced Akathisia. Cambridge University press. SSRI induced akathisia

DSM IV, from (1994) Research criteria for Neuroleptic – Induced Acute
Dystonia 333.99 Neuroleptive-Induced Acute Akathisia 333.82. Research
criteria for 333.99 Neuroleptic-Induced Tardive Dyskinesia. (involuntary
repetitive movements) 333.1 Medication-Induced Postural Tremor, Research
criteria for 333.7 pages 742-751 DSM V1.

Government Response to Report of Health Committee on Parliament Petition
1999/30 of Anna de Jonge and other. Presented to the House of
Representatives in accordance with Standing Order 248.

Blakemore, D (2003) Take note, ECT is not a solution. Healthy Options August
2003.

Burstow, B, (2003) Electro Shock as a Feminist Issue, public lecture,
Canada.

Dawson, J. (1987) The Process of Committal. Senior Lecture at Law, Dunedin
University, New Zealand.

DeCrow, K. (1974) Sexist Justice Random House New York.

de Jonge, A. (1988) Law, psychiatry, and morality: sexual exploitation of
women in New Zealand. The New Zealand Medical Journal No 848. 22 June Volume
101. 431-432.

Frank; L. R. (1978) The History of Shock Treatment. Edited and Published
2300 Webster St San Francisco California 94115 USA.

Horswill, I. (1989) Doctor in Sex Shock. Sunday Star April 16 Auckland New
Zealand.

Horswill, I. (1989) Police never told of doctor’s depraved acts on patients.
Sunday Star April 16, Auckland New Zealand.

Jones, D. (1989) Ex New Zealand doctor banned in UK. Waikato Times, July 12.
Medical Council of New Zealand (1989) Removal from register, Dr K. V. S.
Unni. The New Zealand Medical Journal No 864. 22 March Volume 102, 145.

Johnston, M (2003) MPs want review of ECT. A Committee says shock therapy
should be used only as a last resort. NZ Herald, Friday February 14, 2003.

Kneeland & Warren (2002) Pushbutton Psychiatry by a social-historical
analysis of electroshock in the US.

Medical Council of New Zealand: (1989) Appeal against Erasure, Dr. N.W. M.
J. S. Gurusinghe. The New Zealand Journal No 864. 22 March Volume 102, 145.

Nichol, Ruth (2003) Some former psychiatric patients want electro shock
“therapy”, ECT banned as a treatment. The Dominion Post, Saturday July 5,
2003.

Nicholson, Dannielle (2003) Review of ECT under way. Hamilton Press
Wednesday, April 2003.

Okkerse, M. (1989) Patients should be able to sue doctors, says barrister.
Dominion Sunday Times April 30, p. 32 Wellington, New Zealand.

Priest, Janice-Ann (2002) The Shocking Truth of ECT. Healthy Options July
2002.

Spence, Alex (2003) Positive and Negative. The use of Shock therapy – or
ECT comes under renewed scrutiny as the government announces an inquiry. But
some critics will not be satisfied until it is banned. Listener June 14,
2003.

Studholme, Annie (2003) Reliving the shock therapy nightmare. The Ashburton
Guardian, Thursday May 15, 2003.

Unshackling the Hospital (1988)
Report of the Hospital and Related Services Task force. 11.

Wilson, M. (1989) The Role of The Law in Women’s Struggle for Equality Women
and the Law Vol 1: 21. 203. Waikato University Lecturer Series. 1-12.

If you would like to discuss my paper or require further information please
contact: Anna de Jonge
Anna de Jonge
65 Tawa Street
Hamilton 2001
Ph:Fax: 07 8435 837

The Continuing Critical Debate

Reference:

Other articles available on request or from the net:

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Duty of ‘Care’: Is it Ethical? by Anna de Jonge

The Continuing Critical Debate

Reference:

Other articles available on request or from the net:

Document Actions