In a recent Army Times article, documents were unearthed that revealed the VA lobotomized over 2,000 veterans from WWII. (http://www.armytimes.com/article/20131211/NEWS/312110013/Report-VA-lobotomized-2-000-disturbed-veterans) I’m shocked this is just now coming out, but not surprised some of these treatments to alleviate PTSD were used. Mental health is a taboo subject for most people. We could probably all use some help every now and then, but no one wants to admit it. We all process events differently, some need more help than others. A person will post on social media there battles with cancer or some other hardship, but individuals will suffer in silence with depression or other mental illnesses because others may judge or criticize.
The biggest disturbance of this article is the ethical concern of autonomy. Childress and Beauchamp define autonomy as an individual’s determination in their healthcare decisions. This concept has its roots in the legal case of Schloendorff v. Society of New York Hospital where they ruled, “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.” Maybe the VA made the determination that these individuals were not of sound mind? Part of the process to get this procedure done was getting consent from the nearest relative. However, one must wonder how much information they gave to the nearest relative on the risks, benefits, and likely success of this procedure. The VA was trying to “help” these individuals by using experimental treatments. Sometimes we have to take risks to find new cures and breakthroughs, but we also must be mindful of the negative effects of these treatments. Many insurance companies won’t pay for experimental treatments, this article may be a good argument for that point. I hate to sound cold, but the key to controlling healthcare expenses is ensuring the benefits at least equal, if not outweigh, the benefits. After reading the full article in the Wall Street Journal (http://projects.wsj.com/lobotomyfiles/), there was comment in there that still resonates in the business of health care. It stated, “Despite the absence of hard evidence, there persisted at the VA a belief that the operation left patients better off. Two nurses at the VA hospital in Northampton, Mass., wrote in 1949 that lobotomy offered the possibility—where none existed before—that a vet could someday leave the psychiatric ward and go home again. “It is difficult to put into statistics what it means to say ‘Good-bye’ to a man who a few months before lived in a dark world from which there seemed no exit save death,” they wrote.” We make decisions off personal anecdotes rather than evidence or proof. There is a real confirmation bias we have to be aware of. Individuals want to use evidence to support preconceived notions, and dismiss data when it doesn’t point to the conclusion they support. Who knows how many this treatment helped or harmed? The VA (and lots of other doctors) were using treatments that didn’t have strong evidence (evidenced based medicine) to treat individuals who didn’t have a say in their treatment.
Another interesting observation is how long this took to surface. Individuals who suffered from mental health issues seem to have been marginalized in society. Until we remove the stigma of someone seeking mental health, this may continue to be a problem. We as leaders in healthcare must be willing to fight for those who have no (or limited) voice. At the end of the day our job is to provide the right healthcare at the right time to the right person, no matter who that person is.