Thursday, June 28, 2007

City officials can authorize surgery on people with intellectual disabilities?

The U.S. Court of Appeals for the District of Columbia has upheld the contention of the Mental Retardation and Developmental Disabilities Administration (MRDDA), that city officials are not required to undertake any attempts to identify the wishes of a person with an intellectual disability with regards to surgery, if they have always been declared incompetent to take health care decisions.

Representatives for three women with intellectual disabilities had argued that city officials authorized surgeries for them without attempting to find out their own wishes with regards to the surgical procedure, in violation of their rights under the Fifth Amendment of the U.S. Constitution. However the Court of Appeals has sided with the MRDDA in asserting that people with severe disabilities who have been declared incompetent throughout their lives do not have any rights under the Constitution to refuse surgical procedures upon themselves. Instead the city officials can elect to perform medical procedures considered to be in the best interests of the individual (Ashley treatment, anyone?).

Take a look at the entire decision at http://op.bna.com/hl.nsf/id/psts-74armw/$File/doe.pdf

The justices declared that, "It is undisputed here that plaintiffs have always lacked “sufficient
mental capacity to appreciate the nature and implications of a health-care decision, make a choice regarding the alternatives presented or communicate that choice in an unambiguous
manner.” The entire details of why it is "undisputed" are not explained in the decision.

Hmm, I wonder what the nature of those communications were, and if any accommodations had been made to explain the nature of the condition and proposed treatment in a manner understandable by the individual with the intellectual disability. I believe that it is very important to identify how physicians or psychiatrists declared people to be "mentally incapacitated." As literature shows, individuals with intellectual disabilities can benefit from psychotherapy for mental illness, if modified in a manner conducive to their understanding. However, it rarely is and the same might apply in the case of such competency decisions.

The court has argued that this differs for people who were once competent, but now lack this competency. In their case, officials must undertake efforts to identify their wishes before the onset of their current condition.