My healthcare, and that of my family and friends, is absolutely none of your business. None whatsoever, with all due respect! Yours is none of mine and I’m only professionally interested in a very limited and particular way.
I’ve been asked a few times whether I’m interested in this area of policing because I have personal experience of mental health problems, or perhaps via a good friend or relative? That’s none of your business, as I’ve said. This reply should not be used to construe that the answer is ‘Yes’ and that I’m trotting out privacy rights in order to avoid revealing things. To be honest, I’m trotting out my privacy rights (and those of my friends and relatives) just because I can and because it’s up to me whether I reveal things about my or their health. I’m afraid, I’m a bit like that – private, contrarian and rather fond of my rights as well as being very content with the attendant obligations that always accompany rights. It’s my decision what I choose to reveal about my healthcare and it’s not for me to reveal things about the health of my friends or relatives without their consent or another damned good reason.
If you’re asking, last year, I did have a small health problem and it was my wife who pointed out something I hadn’t realised: that this was part of an emerging pattern which could be a greater cause for concern. Seemed like wise advice from her, so off I trotted and the Doctor gave me some malady-specific advice and medication in addition to one of those fat-man-over 40 MOTs which I’d managed to avoid for three years and it all helped in the short-term whilst putting my mind at rest about a range of other things you start thinking about when you’re a bloke over 40 who rarely goes to the doctor. But when it was more recently suggested I might go to a doctor for another reason, I exercised the right of every sentient person to laugh at the very idea of it, munch on some painkillers and crack on. I have been known to make doctor-related decisions without prompting from anyone else, to take complete responsibility on my own, too – to decide to go to the Doctor without any outside support or encouragement from anyone.
That’s enough of my medical history and it was my decision to share that much of it with you – as was it my decision to keep details about particular maladies private! It’s none of your business, obviously! … I’m sure you’re getting the hang of this already! This is the thing about healthcare, and other aspects of our personal lives: it’s private stuff and we can all choose from where we take advice, whether we act upon that advice or whether we reject it all and do our own thing; and whether we tell the world. Ultimately, it’s up to individuals to make decisions about their health and their healthcare – most of the time. It’s almost never going to be your responsibility.
CAPACITY AND CULPABILITY
Obviously, there are circumstances where these important principles are compromised. Children have far fewer individual rights in these situations and their parents or guardians routinely act on their behalf. Some adults can’t take decisions about their own health, because of injury or illness – if you’ve just been knocked over and knocked out as a pedestrian in a traffic collision, you’ll probably want your friends and relatives, or helpful police and paramedics to start making decisions about what they think is in your best interests and act accordingly.
You can also imagine that if your healthcare issues are driving your behaviour to a point where it affects others, we may expect the police to step in and then work with healthcare professionals to determine what must be done. Do we prosecute the drug addicted burglar or robber, if they are offending to fuel their chemical dependency? – of course, we most usually do. We also do this in some cases where a person has experienced psychosis, but most usually in those rarer cases where they’ve hurt someone else or been found in unlawful possession of items which could be used to cause harm. History shows we do incarcerate people in prisons and in mental health units who pose a risk to others because of their health and addiction issues.
So you could summarise all of this, more or less, as follows –
Decisions about the healthcare of sober, conscious, non-vulnerable adults who have not broken the law is ultimately a matter for them and not for anyone else.
ADVICE AND GUIDANCE
Most of us reject healthcare guidance to one extent or another, whether that is because we eat too much, drink too much or exercise too little. I’d be genuinely interested to know how many adults of working age could say they moderate alcohol within Government guidelines, whilst taking the relevant amount of exercise, eating their Five-a-Day portions of fruit and vegetables within the recommended calorie limit, etc., etc.. We recognise that our autonomy allows us to reject advice because most of us do on at least one of those areas, even where the advice is based on the best available medical and scientific evidence.
So what’s different in policing or medicine, where someone’s healthcare decision isn’t perhaps what we, as professionals advising and guiding, would hope they do? How many police officers and paramedics attend a mental health incident where things are not so serious as to justify restrictive and coercive interventions but where we find it difficult to accept the decisions of people who are nonetheless vulnerable, even if just in our view, if they are rejecting advice. I’ve recently heard a few police officers talking about how they still have to ‘do something’ in a situation where they’ve (correctly!) established they have no legal powers to override someone’s autonomous and, no doubt, unwise decision.
But here’s the legal nugget of this post: an unwise, even stupid decision can still be lawful – a person does not lack capacity by virtue of wanting to behave in a reckless or dangerous manner with regard to their own health. You want to stop taking medication, or walk out of A&E before treatment is completed; you want to decline an ambulance trip to hospital after you fell – all of this is a matter for you, not me … subject to those caveats of whether you have capacity to take your decision; and whether your behaviour amounts to an offence which is impacting upon the rights and safety of others. (And by ‘rights’, I mean the actual legal rights of others, not the ones we make up to justify a moral intervention that has little basis in law.)
Final point: some people have reasons for healthcare decisions which are profoundly important to them and which are morally and intellectually sound, from their perspective. The fact that any professional may disagree and even think the reasons risible, is neither here nor there. If you doubt this, look at the kidney dialysis / paracetamol overdose case where a lady refused treatment because she didn’t want a live of relative poverty and loneliness ‘in a council flat’ getting old. Doctors at the hospital argued that she lacked capacity to take decisions for herself and the Court of Protection rejected this, citing an earlier case –
“An adult patient who… suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered,” … “This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.”
There are lots of examples in policing where we assume that the right thing to do is to take healthcare choices away from people where we would, perhaps, be better advised to help people make choices for themselves. Once someone is under arrest or detained under the Mental Health Act, things are different, but prior to that or where such thresholds are not met, it’s actually none of our business, beyond ensuring people have been advised or sign-posted to options they may not have been aware of, which they may or may not find helpful.
Your healthcare choices are a matter for you – and that means public professionals should respect your right to make your own choices, even if they can’t respect the choices themselves.
Winner of the Mind Digital Media Award.