A correspondent has brought this story to my attention: Aisha Dow, ‘She was a nurse. So why did Helen shun conventional cancer treatment?’, The Age (Online) 21 May 2018. The story relates to an experienced emergency department nurse who, when diagnosed with ovarian cancer, rejected medical care and instead sought care from Dennis Wayne Jensen,
… a self-described healer and hypnotherapist who told her not to undergo surgery.
Instead he allegedly prescribed an aggressive and painful treatment called black salve, which ate away at her flesh, leaving her swollen and in pain.
The reason this matters been sent to me for comment is because it is believed that the patient ‘an emergency department nurse … received a recommendation for Jensen from a paramedic she worked alongside’.
My correspondent says:
The paramedic likely acted with the best of intentions, however should have the medical knowledge (not to mention experience) to know that alternate medicine is not more effective than conventional medicine (otherwise it’s called medicine…)
Does the victim’s qualifications as an ED nurse remove any liability or unethical behaviour from the paramedic? Or did the victim’s vulnerability and desperation negate that?
Had this been been a regular member of the public, or a patient of the paramedic, could the paramedic face penalties – especially once we become registered?
The answer to that question, like so many, is ‘it depends’. I can’t comment on the practices of Mr Jensen as I don’t know what information he gave and whether the patient was competent to make decisions in all the circumstances. Those matters will be addressed by Victoria’s Health Complaints Commissioner. So putting issues of her mental state and her relationship with Mr Jensen aside, we can comment on the law.
First we all have a right to accept or refuse whatever medical care we like. So it was her right to reject medical care and instead look to Mr Jensen if that is what she wanted to do, regardless of how that decision may look to the rest of us.
The issue then is the conduct of the paramedic and that too ‘depends’. A paramedic may have his own view and may offer that advice to a friend who seeks advice. So the first question here would be what where the circumstances in which the recommendation was given. If it was a conversation between peers and friends then it’s not a professional relationship and presumably the paramedic can make whatever recommendation he or she believes in. And the fact that the person receiving the advice is an experienced nurse would be relevant as they, one might expect (again not commenting on her state of mind or competence at the time) should be able to make an informed decision on the value of the recommendation. Equally making the recommendation does not compel the person to take the advice or accept the treatment. That is between in this case the patient and Mr Jensen.
Where the person being given the advice is a patient of the paramedic (or is a friend that is clearly vulnerable and perhaps not able to make an informed decision) then I would suggest the situation is clearly different. As an employee a paramedic is required to comply with the reasonable directions of their employer, so they have to practice paramedicine as directed – they can’t introduce their own alternative practices in the back of the ambulance.
As soon to be registered health professionals they will also have to practice in accordance with accepted peer standards. A person who rings for an ambulance no doubt expects paramedics to deliver evidence based care and transport them to a medical facility if that is called for. The paramedic who thinks they’d be better off with the crystal healers and delivers the patient to an ‘alternative’ care such as Mr Jensen would, I suggest, find their career in paramedicine short lived. But that’s not what is reported here.
Paramedics do not transport everyone to hospital. It’s appropriate, in some cases, for a paramedic to advise a patient ‘you don’t really need us or to go to hospital, you should go to your doctor tomorrow’ (Paramedics and recording honest advice (April 15, 2018)). It’s not hard to imagine that a paramedic with the same world view of the paramedic that gave the advice to see Mr Jensen, might say ‘you don’t need us or to go to hospital, you should go to a quackery tomorrow’. As with my suggestion of transporting the patient, even giving that advice is likely to be judged as conduct ‘that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers’ ie unprofessional conduct or even professional misconduct.
If that is the case then yes, the paramedic who gave that sort of advice may well find themselves subject to professional discipline with the risk of being ‘struck off’ as a paramedic. Whether that’s likely in this case would, I suggest, depend on the pre-existing relationship between the paramedic and the nurse and the nurse’s capacity at the time.
First, can I say, having only discovered this ‘EmergencyLaw’ website, I have found Prof. E’s writing s and case discussions to be very interesting and educational readings!
I think this case reminds us of the cautionary tale of treating family and friends. Whilst it is not illegal to treat your family or friends, it does open potential ethical and professional conflicts of interest, and your ability to remain impartial (as you would by treating a patient you’ve never met socially) is somewhat skewed and therefore so is potentially the diagnostic process and treatment you prescribe. That said, I know many clinicians who have had no issues (thus far) treating family and friends; however, this is a risk I personally rather not take. I personally believe each patient should have their own GP-Doctor, including myself and my family; and I notoriously avoid corridor-consultations from colleagues.
That having being said, that’s not to stop clinicians giving informal advice to friends and family, with the warning that the advice is informal and the patient should take it or leave it, and still seek professional advice from their own doctor.
The dilemma faced in this case is in emergency care (or in rural medicine, as I have encountered), where you are the only clinician available to attend to the patient of whom you know socially (be that friend or family). I think in this case you just have to openly declare you know the patient, and that the patient still consents to being your patient and understands the potential conflicts of interest and that you would normally recommend the option of seeing another clinician; should you decide to proceed to see the patient, I think the clinician should remain professional and try their best to treat them just as they would any other patient and offer the same standard of care and advice-treatment recommendations as any other clinician would of their experience and training..
With regards to the issue if patients wish to pursue alternative therapies to conventional medical treatments, well our job is to properly inform and educate the patient, and advise them of the risks and benefits. As stated, the patient has a right to choose to accept your advice or decline it and seek other medical advice, or go ahead with alternative therapies on their own accord.
Patients have right to refuse treatment presuming if they have competency and capacity and are informed. I think if it’s against your recommendations, you should make it clear in the documentation that the patient has gone against medical advice and has decided to discharge themselves at their own risk. On the other hand, if you recommend to the patient that they do not need to go to hospital, you should ensure appropriate follow-up and discussion of red-flag parameters. I think the issue with Paramedics advising patients who do not need to go to hospital is that they are now accountable and responsible for the follow-up for the patient’s presenting concern (be that the back pain that doesn’t go away and turns out to be a AAA about to rupture). I’ve always erred on the side of caution to send to hospital and/or admit to observe and/or further investigate. The limitations of Paramedical care is that they: a) don’t follow-up with patients, b) do not have option of providing further diagnostic tests, c) have limited referral and treatment options available to them.
I don’t see how paramedics are ‘now accountable and responsible for the follow-up for the patient’s presenting concern’. If a paramedic advises ‘see your doctor tomorrow but if your symptoms get worse tonight, do call us again’ then it’s up to the patient or their carer to actually do one of those things.