Mary Northern Debate
Listen to this audio recording by Matthew Goss, bioethics Masters student, and Dr Joyeeta Dastidar on the great debate over the case of Mary Northern:
Mary Northern was a woman who lived in the greater Nashville area and was taken out of her home and admitted to a hospital, with recommendation to amputate her feet due to the severity of the frostbite leading to gangrene of her feet. She did not agree to this treatment course and adamantly opposed it, indicating that the changes were due to dirt, would improve on their own, etc. These statements brought into question Ms. Northern’s capacity to refuse the recommended treatment. The courts got involved, though the case concluded through natural means prior to enforcement of any court-ordered treatment.
A Systematic Approach on How to Determine Whether to Treat Over Objection
Watch this Mayo Clinic Proceedings video on Nonpsychiatric Medical Intervention, Objection, and Decisional Capacity by Dr Kenneth Prager, Director of Clinical Ethics at Columbia, and Dr Jonah Rubin, an Internal Medicine resident at Columbia:
The video is a review of their article published in Mayo Clinic Proceedings and both include their helpful list of seven core questions to weigh in deciding whether a case merits treatment over objection:
1. What is the likely severity of harm without intervention?
2. How imminent is harm without intervention?
3. What is the efficacy of the proposed intervention?
4. What are the risks of the intervention?
5. What is the likely emotional effect of a coerced intervention on a patient?
6. What is the patient’s reason for refusal?
7. What are the logistics of treating over objection?
Additional resource: Treatment over objection in psychiatry (the most common scenario)
Watch this video by the New York State Office of Mental Health entitled Treatment Over Objection: What Clinicians Need to Know, featuring Dr Paul Appelbaum of Columbia and the New York Psychiatric Institute, and Dr James Hicks, of NYU Langone and the Kirby Center:
References:
(J. Dastidar and M. Goss, personal communication, February 16, 2019)
Mayo Proceedings. (2018, May 30). Nonpsychiatric Medical Intervention, Objection, and Decisional Capacity. Retrieved from https://www.youtube.com/watch?v=q4xBeT0lkSQ
New York State Office of Mental Health. (2013, January 16). Treatment Over Objection: What Clinicians Need to Know. Retrieved from https://www.omh.ny.gov/omhweb/bps/130116_treatment.html