What Does the AMA Say About Forced Catheterization?

A few days ago, when I wrote about a guy who was forcibly catheterized to test if he was driving drunk (he wasn’t) it seemed to me that this violated the requirements of medical ethics that medical procedures should only be done with the consent of the patient and for the benefit of the patient.

At the time, I thought that the AMA Code of Medical Ethics might address this in opinion 2.065, but I wasn’t sure if I was reading it right, so I emailed the AMA press office:

I write about legal issues and civil rights. I’d like to know if the AMA has a policy addressing issues raised by a recent news story.

(See http://www.wlwt.com/health/20703731/detail.html)

It appears that Lawrenceburg, Indiana, police arrested Jamie Lockard, 53, for drunk driving, and got a judge to sign a warrant for a blood and urine test.  At Dearborn County Hospital, someone inserted a urinary catheter against against his will.  (All this according to a lawsuit he has filed.)

Some questions I have:

Has the AMA issued a statement about this incident or the lawsuit?

What is AMA policy with regard to medical testing (and associated procedures) conducted solely to satisfy a police investigation—i.e. there is no medical benefit to the patient?

Shouldn’t medical professionals refuse to perform the test if the patient does not consent?

If a medical professional is faced with a patient who has been ordered by a court to undergo a medically unnecessary procedure against his will, does the court order override the usual concerns about consent and medical efficacy? As long as the medical professional himself is not a subject of the court order, isn’t his primary duty still to the patient rather than the legal system?

The response from the AMA was minimal, which is what I expected given that I’m just a humble blogger. They sent me to these two sections of the code of ethics: 

E-8.08 Informed Consent

The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The patient should make his or her own determination about treatment. The physician’s obligation is to present the medical facts accurately to the patient or to the individual responsible for the patient’s care and to make recommendations for management in accordance with good medical practice. The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice. Informed consent is a basic policy in both ethics and law that physicians must honor, unless the patient is unconscious or otherwise incapable of consenting and harm from failure to treat is imminent. In special circumstances, it may be appropriate to postpone disclosure of information, (see Opinion E-8.122, “Withholding Information from Patients”).

Physicians should sensitively and respectfully disclose all relevant medical information to patients. The quantity and specificity of this information should be tailored to meet the preferences and needs of individual patients. Physicians need not communicate all information at one time, but should assess the amount of information that patients are capable of receiving at a given time and present the remainder when appropriate. (I, II, V, VIII) Issued March 1981. Updated June 2006, based on the Report “Withholding Information from Patients (Therapeutic Privilege).”
 
E-2.065 Court-Initiated Medical Treatments in Criminal Cases

Physicians can ethically participate in court-initiated medical treatments only if the procedure being mandated is therapeutically efficacious and is therefore undoubtedly not a form of punishment or solely a mechanism of social control. While a court has the authority to identify criminal behavior, a court does not have the ability to make a medical diagnosis or to determine the type of treatment that will be administered. In accordance with ethical practice, physicians should treat patients based on sound medical diagnoses, not court-defined behaviors. This is particularly important where the treatment involves in-patient therapy, surgical intervention, or pharmacological treatment. In these cases, diagnosis can be made initially by the physician who will do the treatment, but must then be confirmed by an independent physician or a panel of physicians not responsible to the state. A second opinion is not necessary in cases of court-ordered counseling or referrals for psychiatric evaluations.

A recognized, authoritative medical body, such as a national specialty society, should pre-establish scientifically valid treatments for medically determined diagnoses. Such pre-established acceptable treatments should then be applied on a case-by-case basis.

The physician who will perform the treatment must be able to conclude, in good conscience and to the best of his or her professional judgment, that the informed consent was given voluntarily to the extent possible, recognizing the element of coercion that is inevitably present. In cases involving in-patient therapy, surgical intervention, or pharmacological treatment, an independent physician or a panel of physicians not responsible to the state should confirm that the informed consent was given in accordance with these guidelines. (I, III) Issued December 1998 based on the report “Court-Initiated Medical Treatment in Criminal Cases,” adopted June 1998.

That second section is the one I thought might apply.

Technically, the AMA spokesperson didn’t even go so far as to say these sections apply to the incident under discussion, so this is hardly definitive, but I think I’m on the right track. Something went wrong here.