Re: Managing vulnerable patients

Issue: BCMJ, vol. 63 , No. 5 , June 2021 , Pages 199 Letters

I was interested to read the April 2021 article, “Management of vulnerable adult patients seeking to leave hospital: Understanding and using relevant legislation,” having had just such a conundrum during my shift the previous evening. Unfortunately, the article did not specifically address a certain common situation. Any insights from the authors would be much appreciated.

Incapacity due to addiction

By my reading of the article, my patient (whose parents were strongly advocating be involuntarily admitted due to severe and progressive self-neglect as a result of alcoholism) fulfills the criteria to allow treatment under the Adult Guardianship Act (AGA) (1. self-neglect, 2. risks, already experienced—e.g., loss of licence to drunk driving, assault charges etc., and 3. incapacity due to chronic unremitting intoxication).

It is not regular practice to force treatment due to addictions. This patient was kept under the Health Care (Consent) and Care Facility (Admission) Act until sober enough to ambulate safely and have a discussion regarding his situation, at which point he could voluntarily continue treatment or leave against medical advice.

Is this sober window (reportedly the only such window in a very long time) enough to allow the patient to voluntarily proceed back into his state of chronic alcohol-induced incapacity (not withstanding that the illness of addiction renders the patient incapable of avoiding further intoxication)? If it is not, should we be using the AGA routinely in cases of addicted vulnerable adults?

Also, the fictional case of Ms Safe was a useful illustration. I imagine the statement that she’d “be fine” was explored in more detail. What if she’d meant: (1) I’ll be fine because I wish to die from this illness, or (2) I understand the risks you’re telling me but I’ll be fine with the natural medicines I’m using, or my faith that God will heal me?
—Roger Seldon, MBChB, MD
Campbell River

This letter was submitted in response to “Management of vulnerable adult patients seeking to leave hospital: Understanding and using relevant legislation.”

Read the authors’ response in “Re: Managing vulnerable patients. Authors reply.”

Roger Seldon, MBChB, MD. Re: Managing vulnerable patients. BCMJ, Vol. 63, No. 5, June, 2021, Page(s) 199 - Letters.



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