The Bioethics of Mandatory Observation Periods after Overdose

Jenna Mustafa – Hackensack Meridian School of Medicine; Connor Wirth – Hackensack Meridian School of Medicine

Abstract: The opioid crisis is continually challenging for those who suffer from opioid-use disorder and those who care for them. 60,000,000 people across the globe experience opioid addiction, with over 100,000 overdose deaths yearly. Mandatory holds of persons who have suffered an overdose and received naloxone have come under bioethical scrutiny because of questions about their ability to make autonomous decisions. Given variations in the amount of medication lingering in a person’s system post-naloxone resuscitation, capacity for decision making is unclear. Even if a person appears to have the capacity to consent, motivational differences relative to their real self or the ability to weigh risks differently than they would otherwise, might be compromised according to some ethicists. Thus, mandatory observation periods may lead to the violation of patient’s autonomy. To the contrary, it is argued that mandatory holds are ethical and are not a violation of autonomy. Though such holds may appear paternalistic (and careful analysis may support claims of capacity in a subset of patients in the aforementioned state), the bioethical issues ought not be framed along the autonomy-paternalism spectrum or even as a conflict between the principles of autonomy and beneficence, but rather as an issue of implied consent. After arguing in favor of this framing over the other options, it is argued that mandatory holds need not be paternalistic, fit emergency medical practices, and are both ethically and epistemically sound. The presentation concludes by recommending mandatory hold policies be adopted by healthcare institutions and supported by clinical ethicists.

Keywords: overdose, mandatory hold, autonomy