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Quick Tip for Families in Intensive Care: Is It Legal or Ethical to Interrogate a Critically Ill Patient in ICU Under the Influence of Sedation?

Today I’ve got Peter asking whether it’s ethical and legal to be interrogated whilst unconscious in ICU.

My name is Patrik Hutzel from intensivecarehotline.com, and I’ve got another quick tip for families in intensive care.

So today, I have an email from Peter, who asks the following, and I know Peter has been a patient in ICU in the past. Peter has the following question.

“I would like to ask if you know if there’s any form of precedence for being interrogated whilst unconscious in ICU. Whilst in an induced coma in Australia and unable to defend oneself under the effects of medicine, delivery via syringe pump via central line with fentanyl, rocuronium, ketamine medical infusion. 

As I’m aware that under the Human Rights Act or the Mental Health Act, these actions without consent are generally considered highly illegal in most instances, especially when asked non-relevant medical information questions, which could then be used against your critically ill loved one in their future healthcare treatments. 

As I’m aware of the practice within the medical establishment due to being poorly medicated and able to remember the experiences and now thus effectively able to highlight the facts surrounding the concerning process that can occur in ICU departments. 

Your integrity to honestly answer these questions is a demonstration of your years of experience and to the great advantages of anyone using your invaluable services of Intensive Care at Home and intensivecarehotline.com services for which I can highly recommend as inspirational and truly inspiring in helping to benefit the recovery of critically ill patients leading to a better quality of life for them, better outcomes, and of course includes their families.

From, Peter.” 

Thank you very much, Peter, for raising this very serious and also complex issue.

To address your question directly, and this is obviously from my research, there is no lawful precedence or ethical justification in Australia or in most democratic countries for interrogating a patient who’s unconscious, sedated, or under an induced coma or even paralyzed in ICU, especially on the medications such as fentanyl, rocuronium, and ketamine, which are known to induced amnesia, paralysis, and loss of consciousness.

Anyway, any attempt to question such a patient, particularly for non-medical purposes or with the intent of extracting information to be used against them or their care decisions, could constitute a serious breach of medical ethics, patient rights, and potentially criminal law.

Let’s look at the legal and ethical context not only in Australia, but also in most democratic countries.

Human Rights Act in Queensland, Victoria, and ACT in particular, these laws uphold the right to freedom from inhumane or degrading treatment and privacy and require informed consent for any interaction beyond essential life-saving measures. The Australian Charter of Healthcare Rights, endorsed by the Australian Commission on Quality and Safety in Healthcare, clearly supports respect for patients and families; the right to participate in decisions about their care and the right to privacy and confidentiality.

Next, Mental Health Acts vary by state. Even when a person is deemed to lack capacity due to sedation or coma, they are still protected under guardianship and substitute decision-making frameworks. Any questioning not related to immediate care is highly inappropriate and likely unlawful.

Next, medical and ethical violations. Sedated, comatose, or paralyzed patients, or chemically restrained patients do not give consent, nor can they be expected to process or respond to questions. Using information gathered under these conditions to inform future care or legal decisions without transparency and consent would likely violate informed consent doctrines and could be challenged legally.

Next, documentation and reporting. If you or a critically ill loved one has experienced this, document everything you remember, dates, names, statements, sensations. Request medical records, especially progress notes and any audio or video surveillance, if applicable, and many hospitals now do have video surveillance.

Next, file a complaint with the hospital’s patient liaison or ethics committee and hospital executive, also with your state’s Health Complaints Commissioner, and with the Australian Health Practitioner Regulation Agencies such as AHPRA if any individual clinician was involved.

Your ability to remember and report these events despite sedation should not be dismissed and may reflect gaps in protocol, possible overuse or misuse of paralytics and sedation, or neglect of your rights.

I hope that helps you understand what your rights are, and it also hopefully helps you understand that it’s inappropriate to use such tactics when someone is still in an induced coma or is coming out of an induced coma and is certainly not in a position to be interrogated.

I think what also ties in this question is  that we hear from families all the time, and obviously I’ve seen it in ICU myself, that when patients are unconscious, especially when there’s negative news, that they are being discussed in front of a patient, whether they are awake or not awake. That is very concerning because, just because a patient is supposedly in an induced coma doesn’t mean they can’t hear. Sometimes they can, and you know there’s different reports. Some patients in an induced coma, they remember everything and then there are other patients, they do not remember a single thing.

It’s not a one size fits-all. Therefore, intensive care teams need to be very careful what they’re saying in front of a patient, in front of the family as well. It requires tact and also bedside manners to, imagine you’re talking to an unconscious patient or supposedly unconscious patient and you’re telling them in front of the patient that they’re unlikely to survive. What does that do to their chances for recovery? it’s not good. And many families rightly say to intensive care teams, stop doing that in front of my loved one. I only want them to hear positive news; I think that is really important for you to understand.

But in any case, it’s also good to see that patients or families in intensive care share what other questions and concerns they have in terms of, other ethical or moral implications that their stay in ICU has, besides just the clinical. Intensive care teams need to pay attention to that. In any case, I hope that helps you understand the framework around these situations, Peter.

I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting advocacy.

You can verify that on our intensivecarehotline.com testimonial section and also on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing. That’s why we have helped so many families in intensive care to improve their lives instantly, making sure they make informed decisions, have peace of mind, control, power, and influence so that their loved one always gets best care and treatment.

That’s why I also I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you and I talk to you and your families directly. I hand-hold you through this once-in-a-lifetime situation that you simply can’t afford to get wrong. And I also talk to doctors and nurses directly with you or on your behalf or I set you up with the right questions to ask. And when I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real-time so that you can get a second opinion in real-time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I’ve personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

 

Take care for now.