Conflict between parents and doctors: when can mandatory care be imposed?

Emergency measure imposed by the mayor 

The girl's parents requested in the ruling that the hospital allow the girl to receive three B12 injections weekly for two weeks. They also sought to prohibit the hospital from administering lorazepam and ECT during this period. However, the doctors at Amsterdam UMC believe it is irresponsible to suspend the treatment with lorazepam and ECT. Buijsen explained in the podcast, "Sometimes people exhibit behaviour due to a mental disorder that makes them a danger to themselves or others. In such cases, the mayor has the authority to impose an emergency measure." 

An independent psychiatrist advises the mayor when making this decision. Buijsen noted in the podcast, "Of course, the intention is to hear the patient or their representatives if possible, but ultimately, it is the mayor who decides." He continued, "But in this case, it is impossible to obtain consent, and if nothing is done, the patient's health or even life is at risk." 

Professional standard 

Buijsen stated in the podcast that it is often misunderstood that patients have the right to treatment according to professional standards. He explained, "Treatment according to professional standards means that doctors are obliged to follow guidelines as evidence-based as possible, meaning scientifically substantiated therapies. You cannot ask doctors to do things they consider medically futile. Various norms bind them, and these norms do not allow doctors to perform medically pointless procedures; they are not permitted to offer such to patients. So what you can expect from a doctor, whether it is mandatory or voluntary care, is treatment according to the professional standard. You cannot expect or demand anything else from doctors." 

The parents argue that the B12 injections are a matter of 'It does not hurt to try.' However, the doctors disagree with the parents. The girl has not been diagnosed with a vitamin B12 deficiency. Additionally, the injections are invasive and painful, as the procedure repeatedly damages the skin with the needle. The court has rejected the parents' request. According to the judge, administering B12 injections is neither scientifically supported nor necessary. Therefore, according to the court, this treatment does not meet the professional standard. Buijsen explained when forcing a treatment might have a chance of success: "Sometimes parents or patients try to get a judge to approve an experimental treatment. This can be successful if the patients can find scientific evidence in the international literature." 

A Special Curator 

The court in summary proceedings appointed a special curator for the girl for a period of six months. In certain cases, the Child Care and Protection Board can request the appointment of a special curator. Buijsen explained in the podcast, "In the case of mandatory care, the patient or their representatives should be as involved as possible in the treatment, so there must be honest consultation with the patient or, if that is not possible, with their representatives. However, in this case, the judge feels that communication is not going well anymore, so the judge found it wise to add some lubrication to the relationships in the form of a curator. This curator will consult with the caregivers and communicate with her parents." 

When asked how often a special curator is appointed, Buijsen responded, "That is quite rare. This is not a curator who can make decisions on behalf of an incapacitated patient regarding medical treatment. This is not voluntary but compulsory care. In this specific case, the judge deemed it wise for the caregivers to consult with this curator and not - given the history - with the parents." 

Appeal 

If the girl's parents disagree with the ruling, they could appeal. In that case, they might request a suspension of the ruling's execution. Buijsen noted, "The judge has now reviewed this issue three times: during the extension of the emergency measure, in the appeal against the decision of the complaints committee, and in the summary proceedings. The procedure for the care authorization was still ongoing at the time of the court's ruling in summary proceedings. That would be the fourth judicial decision, and a possible appeal in summary proceedings would be the fifth. If the parents want to have any hope of success, they will need to come up with different arguments than those they have previously presented."