Nothing on this page is intended as personal legal advice. For legal questions, it is important to consult an attorney in your own community.
By Melissa Lackman, Esq.
Your child with a disability has discovered that he has a right to medical privacy and decides to shut you out of the information loop. He then immediately stops his medication and begins to deteriorate. You are still legally responsible for his care, but can’t get the information you feel you need.
Or your adult loved one has not given consent for you to discuss his case with his doctors, and you have pressing concerns about how he is doing.
Or you’ve been lucky, and your loved one trusts you and wants you involved in medical decision-making. But you know this could change and you want to have a plan in place to protect your loved one.
It can be heartbreaking to stand by and watch a loved one deteriorate because they have refused medical care for their disability. If the loved one is an adult, we may feel powerless to even have our voices heard by doctors and nurses. Each state is different regarding when a minor can claim medical privacy and assume responsibility for their own care—but in some states the age is as low as fourteen!
There are a number of thing that we can do to address this situation. There is no guarantee of results, but it helps to know what choices are available to us.
First of all, we can pray for our loved ones, that God will care for and protect them, and that His will be done in their lives, and that they will know His love.
We can keep the notebook and charts and journals we have already talked about. In a conflict situation, these can help us to advocate for our loved ones. This kind of recordkeeping helps to establish that you are an important and proactive team member.
We can educate ourselves as much as possible on our loved one’s disability. If there is a mental illness, we can read everything we can find on that illness. This helps us to be respected as a team member concerning our loved one’s care.
In many cases, mental illness causes disordered, distorted thinking or psychosis, which may be contributing to the patient’s refusal of medication. In those cases, it is important to report these symptoms to the treating physician. Doctors cannot release private medical information to you without the patient’s consent, but they can listen to what you share with them about a patient’s symptoms. So don’t be afraid to pick up the phone and let the doctor know you have something you need to share with them. It would be helpful to the doctor to have examples of exact quotes of things your loved one has said that indicate his thinking may be confused.
When the adult loved one is in a period of relative wellness, we can talk with them about their wishes should their illness lead them to refuse treatment. There are documents called advance directives that allow a person to state what they would like done for them in this circumstance. If your loved one would like to have you step in when distorted thinking is causing unwise and unsafe choices, you should speak with an attorney in your community who is familiar with Estates and Trusts and Conservatorship law.
If our loved one is incapable of making informed decisions about his own care, we can consider seeking a court-ordered conservatorship. This would in some cases allow us to take over medical decision-making. This varies state-by-state, so again you would need to talk with an attorney in your own community.
If your loved one is refusing care and creating chaos in your home, there may come a time when the most loving thing to do is set a boundary. You may require compliance with treatment as a condition of living in your home. Setting and enforcing a “tough love” boundary is at the least challenging, and should be surrounded by prayer and preparation. Here are some resources:
You may find comfort and guidance by attending Al-Anon meetings in your community, even if chemical dependency is not the issue in your home.
Finally, if your loved one is a danger to self or others, is threatening suicide or harm to others, cannot tend to his own food, clothing or shelter, it is time to call for immediate help. Place the call to 911 and tell them there is a psychiatric emergency. In my community, the county sheriffs will come and evaluate the situation, and if they believe there is an immediate danger, they can have the person involuntarily hospitalized for up to seventy-two hours. During hospitalization, the patient is evaluated and medications are adjusted. After the seventy-two hours, the holding period can be extended after a hearing if the patient is still a danger to self or others.
You may wish to do a search engine inquiry using the terms “involuntary commitment in (Name of state)” to learn more about the procedures in your own state.
Melissa Lackman is a member of the California Bar, not currently in active practice. She is married to Vernon, a physician, and is privileged to be the mother of three children.