Involuntary detainment for the purpose of denying medical care is increasingly common for patients with vague, unclear, or “contentious” diagnoses like ME – a strong sign that the “Somatoform Wars” has reached a dangerous pitch. To fight for Karina, and to fight this growing threat generally, it’s important to be clear about exactly how rights have been violated.
1. Early Facts
Karina Hansen, a twenty-five-year-old Danish woman, has been disabled for many years by severe Myalgic Encephalomyelitis, an extremely painful neuro-immune condition long recognized by the World Health Organization. Psychiatric evaluations in her case reveal a perfectly clean bill of mental health repeatedly. In 2012 psychiatrists with the Danish national health system pressured Karina and her family to accept inpatient treatment at the Hammel Neuro center, where they believe all ME patients require mental health treatment rather than medical treatment.
Opting for the opinion of her doctors instead, Ms. Hansen declined Hammel’s dual treatment program of “Cognitive-Behavioral Therapy” and “Graded Exercise Therapy”, having found in the past that this approach greatly worsened her symptoms. Her primary care doctor agreed with this decision as one she had the capacity to make and refused to sign involuntary treatment papers when requested to do so by Hammel psychiatrists. In keeping with Karina’s right to informed consent, her autonomous wishes as a patient were respected by the psychiatrists and social workers, as the patient was found to be mentally competent by the Danish medical officer in the case.
2. Initial Events
In February 2013 respect for Karina Hansen’s autonomy was overturned, when five police officers arrived at the Hansen home with a collection of doctors and social workers. Physically blocking her parents, the police forcibly removed Karina from her bed as she protested to the fullest extent her illness would allow.
Once strapped onto a gurney, Karina was transported by ambulance for involuntary treatment at the Hammel Neuro center in Aarhus, frantically calling and texting messages pleading for rescue until her strength ran out and her phone lost charge, the last an emergency call to the police.
After she was removed the home was examined and photographed in detail, including the contents of the refrigerator and medicine cabinet, in an apparent effort to support claims of medical abuse, or “over-medicalization” against Karina’s mother, who cared for her full time. The photographs lent no support to such claims, and the idea of medical abuse was dropped.
Karina gave her parents legal power of attorney after the 2012 incident, but they have never been informed as to the basis on which Karina’s right to make autonomous medical decisions was overturned. It remains entirely unclear how it could be legal for Hammel or Court to ignore a legal power of attorney signed by a patient overtly verified to be legally competent.
The treatment program at Hammel was developed at The Research Clinic for Functional Disorders and Psychosomatics nearby, by the same psychiatrists involved in, and advising on, Karina’s care. The program is administered by psychiatrists, and it stipulates the withdrawal of medications in favor of mental health therapy, but it presents itself as a medical treatment rather than psychiatric treatment, and its website states that its patients are “not mentally ill”.
It is grossly unethical to treat a patient medically against her will. Refusal of treatment is a universally accepted patients’ right, and a human right protected by the European Convention on Human Rights. For this reason, Karina Hansen’s forcible treatment is an egregious human rights violation no matter what her diagnosis and optimal treatment might be.
3. Current Conditions
Karina has been held against her will without medical care for an established diagnosis of the neurological disorder myalgic encephalomyelitis for fourteen months now, against the wishes of her general practitioner, who resigned in reaction to her case. During this time she has endured a forced mental health treatment program she rejected on record in 2012 when established to be legally competent. This approach to ME directly conflicts with the World Health Organization’s classification of the disease.
Tasked by the Danish government with overseeing the care of the country’s ME patients, the Clinic program followed at Hammel describes the severe pain endured by ME sufferers in its brochures as a “bothersome” symptom lacking a medical cause.
Karina has not been permitted to consult with her own attorney to demand respect for her rights to medical treatment and freedom. Because she is forced to endure daily activities known to worsen her condition (among them is probably “graded exercise therapy”), it is unlikely she would have the strength to participate in a legal battle at this time.
Karina’s doctors of choice have been prohibited from involvement in her care because they feel she needs medical treatment rather than mental health care. An international ME expert concerned about her case has offered to come to Denmark to assist (at the expense of a patient support organization), but he has been rejected.
Because Karina’s parents disagree with her treatment, she is not permitted to see or speak with them, though they continue to fight for her freedom. Karina’s sister, a nurse who’s cared for her in the past, was permitted a visit in April 2013, when she agreed to overtly support the current treatment approach, but she found herself unable to keep from breaking down in tears when she saw how severely Karina had declined. She reports that Karina is too severely ill to communicate, and did not seem to recognize her sister.
4. Matters of Human Rights
The CDR is a medical organization focused on ethics, so our concerns always center on a patient’s rights – especially the right of an ill patient to medical care from her doctor. While patients’ rights are indeed a special kind of human rights, there are also central human rights issues that arise in a case like this, and it’s important to acknowledge those directly at the outset.
In any democratic society, there are provisions in place to ensure multiple voices are heard when decisions must be made for those who cannot make decisions for themselves. These include:
- Prior determinations of wishes on record.
- Legal power of attorney, that is, someone specified by a patient who will make sure her medical wishes are known and respected in the event that she is unable to speak for herself.
- Choice of attorney. Patients with Karina’s foresight and intelligence secure an attorney when there seems to be a threat of forcible treatment looming. The attorney, along with the legal power of attorney, ensure that doctors can never tyrannically dictate the course of a patient’s life when she becomes incapacitated.
In Karina’s case, however
- Medical wishes on record were overridden when compliance was forced through the physical strength of five police officers. At this time there still has been no date set for a hearing on the legality of Karina’s forcible detainment and treatment. After fourteen months of detainment without medications for excruciating pain, clearly this violates Karina’s right to due process.
- The authority of Karina’s legal power of attorney, her parents, to make decisions on her behalf has been ignored by Hammel, and that egregious violation of rights has been supported by the Court. The appointment of a guardian who accepts her forcible detainment and withdrawal of medications in no way mitigates the seriousness of this act on the part of the Court. It is a clear violation of rights for a dissenting legal power of attorney to be silenced in favor of a new appointment who does not express dissent against the Court’s opinions.
- Karina’s choice of attorney has been ignored by the court. Her inability to organize and express her desire to see her attorney, or her desire to fight for her rights, has been caused by Hemmel’s own actions and cannot justly be construed as assent.
The details of Karina’s world – the roles of her doctors, her parents, and her lawyers – have been dictated by her psychiatrist to an extent that is truly staggering, in a way that very clearly violates fundamental human rights. Moreover, her psychiatrist has taken the extra step of barring visitation and phone conversations with all those who disagree with forcible detainment and withdrawal of medications. Yet again, the court has granted him this indefensible level of authority. While in cases of involuntary treatment for psychiatric illness psychiatrists do have the power to determine visitation, Hammel’s claim to a medical approach makes it impossible to defend this intrusion into the personal relationships of a patient.
It is the view of the Coalition that human rights violations in the case of Karina Hansen urgently require, and clearly deserve, immediate remedy on the part of the Danish government. Moreover, these violations warrant action on the part of human rights watchdogs because, while such organizations generally prefer not to interfere in individual medical or mental health cases, it cannot be reasonable for injustice to stand merely because it is perpetrated upon a patient. Every case where human rights are violated to this extent, and with this degree of clarity, cries out for action on the part of the human rights community.
You can read a good post about RAT, rapid covid testing at http://diagnosticrights.org/toddler-tips-for-covid-rapid-antigen-tests/