In Which a Bunch of Libertarian Types Go Full Wookie…

… and fit Ambulance Driver for a swastika and a pair of jackboots while he sleeps.

Seems like my high school guidance counselor was right when she said that "fascist tool of the totalitarian state" was the perfect career choice for me. And all this time, I figured I was just a simple paramedic.

In response to Tamara's link to my Lines In The Sand post, a couple of people went into a bug-eyed, slobbering, incoherent rage took umbrage at my assertion that you don't have the right to refuse care if you have expressed, by word or deed, a desire to kill yourself.

Actually, that's pretty much the law in my state and a bunch of others, but let's take a moment to delve into how, by the convoluted reasoning of some, my following that law is the moral equivalent of herding Jews on the train to Auschwitz.

And yes, people actually said that.

Like TJIC, for example:

How does this differ from "OK, Jew, I understand that you want to leave this prison camp, and that would be OK by me, EXCEPT for the fact that I'd get written up and get three demerits if I let you, therefore I won't let you – your actions have consequences for other people, and you have to realize this!"

Wow. Just… wow.

I guess I shouldn't have taken my "I am TJIC" badge down off my blog, huh? While I appreciate that Travis might have a sore spot or three about having his rights trampled over words he said, that statement is a perfect example of why many don't take libertarianism seriously.

I mean, you get a bunch of individualists who are passionate about personal freedom and smaller government, people who are legitimately concerned about the encroachment of government on our personal freedoms, whose general approach to life is "You leave me along and I'll leave you alone," and invariably there is one in the bunch who says something so far out in friggin' left field that the rest of them want to sidle away, eyeing him nervously all the while.

And in so doing, alienate about 75% of the fence-sitters who might be sympathetic to their cause.

But hey, more power to you, Travis. You stay militant, brother!

If you really equate me transporting someone whose words or deeds demonstrate that they may not – at least in the eyes of the law – be in full possession of their mental faculties, with a Nazi trooper herding Jews onto a train to a concentration camp, then we really have nothing else to discuss.

Have a big libertarian "Go fuck yourself!" and have a nice day. 

A fellow with the handle of ILTim also opines:

"Who the fuck are you to decide that a person should be dragged against their will to gitmo/ fluffy bunny land/ wherever you please? That type of personal violence could and should be resisted in every way available and necessary including lethal force."
 

Well, here's the thing, Tim. If you were that willing to use lethal force, you damned sure should have used it on yourself before the cops and EMT's got called to the scene. If you're that slow, or you're running your mouth about it, you're going to the hospital. And if you try to resist by lethal force, I'm gonna go hide behind the engine block of my ambulance while the cops ventilate you thoroughly with .40 caliber holes.

And after my shift is over, we'll go hit the local jackbooted thug bar, I'll buy them all a beer for saving my life, and we'll do a few Nazi salutes and read selected passages of Mein Kampf together.

First of all, I don't get to decide. I just get to transport them to the place where someone with more training than me in psychiatric care decides. I didn't make that law, I'm just subject to it. I suppose I could just shrug my shoulders and say, "Your life, your choice," and walk away, but when I get sued – and I will get sued – the only way I'll get away with it is if I have a jury full of people like you and TJIC.

Except, guys like you would never make it onto that jury. You'd be outside the courthouse wearing a sandwich board, screaming "SHALL NOT BE INFRINGED!" for the television cameras, while everybody watching mentally relegates you to the same niche as the disheveled guy on the next street corner, wearing the sandwich board that says, "REPENT, THE END IS NIGH."

If that makes me a moral coward in your eyes, then so be it. Your opinion of me doesn't cost me much sleep. Grab yourself a picket sign and hang out in Moral Absoluteville with TJIC, while the rest of society does its best to ignore you. Me, I'll still be here, trying to convince people of the rightness of libertarian ideals, and likely making more headway because I'm not spouting off crazy shit like comparing EMT's to Nazi death camp guards.

The whole point of that post is that words have consequences. Travis discovered that very thing, and apparently hasn't learned anything from it. In a way, I find that admirable…

.. from afar.

I say "from afar," because while it's nice to hold people up as heroes, heads bloody but unbowed and all that, up close and in person they often turn out to be unreasonable assholes. In any case, I imagine Travis will lose as little sleep over my opinion of him as I will over his opinion of me. I just wish he realized that people with his attitude make far better symbols than effective advocates.
 

On the brighter side, there were some reasonable voices in the crowd. Roberta X:
 

 "Killing yourself: a legitimate exercise of the right of self-ownership.

Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.

The threatener is initiating force-by-proxy on those with whom he shares his threats.

Dammit, this isn't rocket science."

You'd think so, wouldn't you, Robbi? I wonder if it would matter if I told them I support assisted suicide laws. You do have a right to self-determination. Just don't get me or my livelihood entangled in it by threatening first. And if calm and reasonable people took that stance and voted on it, more than three states would have assisted suicide laws. Instead, at least 35 states still explicitly criminalize it, due in part because every time Jack Kevorkian got on television and talked about it, he wounded up sounding like, well… TJIC.

Yrro Simyarin opines:

I in no way blame you for enforcing the law as written. It isn't your duty to throw your career away and the good you do otherwise as a political protest.

But man, that law is messed up. I think the real takeaway here is "never call 911 if someone you love says they're going to kill him/herself, because you're just about destroying their life." Talk to them, try to get them help, but make damn sure it is all voluntary and not involving the authorities.

 

I agree 100%. The law is indeed messed up, but it isn't my duty to throw my career and livelihood away to protest it. And I like my career. I do a lot of good. I'm not going to walk away from it, as TJIC suggested: "If you're unwilling to allow other people to be free because it would give you demerits at work, maybe you're in the wrong line of work."

It isn't a "line of work" for me. It's who I am. Don't want me interfering in your decision to off yourself? Fine. Don't. Get. Me. Involved.

It's that simple. My number is 911. Don't call it, or don't make spiteful threats that spur other people to call it. Just get on with your business, preferably alone and in private.

But I will offer slight disagreement to one part of your comment: "I think the real takeaway here is "never call 911 if someone you love says they're going to kill him/herself, because you're just about destroying their life."

Suicidal ideation is often a spur-of-the-moment impulse. Unfortunately, people often act on that impulse, and many of them are not in full possession of their faculties when they do it. That's why the laws are as they are. I concede the point that some people, in full possession of their wits, make a cold and rational decision to end their life.

For such people, I think that's a legitimate act of self-determination, one I wouldn't interfere with.

The sticky part is differentiating the (temporarily) mentally ill who make the decision on impulse, from those who make it after rational deliberation. Most laypeople can't tell the two apart, and make no mistake, the 911 operator and the person on the other end of the Suicide Hotline is a layperson. They have very little medical training, if any. What they have is a script, and a set of protocols.

So when you call the Suicide Hotline, they will often turn right around and call 911, thus getting the cops and EMT's involved. Now, I have serious problems with that approach, but you can blame our litigious society for that one. People are afraid of liability. You should be able to call a mental health hotline without fear of the cops banging on your door. Unfortunately, that is not always the case, and the cops and EMT's are not in a position to change it.

But you shouldn't hesitate to seek help for someone who is legitimately despondent and suicidal, even to the extent of calling 911. You could very well be saving their life, not ruining it. As I stated before, often these states are temporary. With medication and counseling they often can and do get better.

Sometimes the medication and counseling does no good, especially if it only consists of doping them to the eyeballs with antipsychotics and warehousing them for a week or two.

But here's where I reject TJIC's and ILTim's indignation out of hand. If someone rationally and deliberately decides to kill himself, as opposed to someone threatening it out of spite, there is nothing that I, or the cops, or an army of psychiatrists can do to stop them. Most often, they'll just do it, and we find their bodies later.

If, on the off chance that we intervene in time, they'll go to a psych ward for 48-72 hours, where they will soon be released, because they rationally and deliberately play the game, do whatever it takes to get set loose, and then go about carrying out their plan.

And it's damned easy to do, because they're not insane. Contrary to popular belief, sane people do not get locked in psych wards for appreciable periods of time. Oh, there are horror stories here and there where that has happened, but that is far from the norm. In fact, it's just the opposite; the system is so beleaguered that a great many mentally ill who should be in inpatient facilities are out walking the streets, getting zero care.

Nor is me transporting you to the ED for a psych evaluation any guarantee that you will be committed involuntarily. That's a fact lost in the comments from the post in question. The person who puts you in the psych ward has to have MD behind their name. The cop or the guy with EMT-P doesn't get to say whether you're sane or insane, he just has to get the patient to the MD to make that determination. And fairly often, the patient convinces the ED physician that the statement was made in jest, or in anger, or wasn't said at all and the 911 caller was just lying to be spiteful, and the patient gets to go home. Convincing the doctor that you're no danger to yourself is fairly easy… if you're no danger to yourself. It's something any calm, rational person can do.

And once you're home, you can go on about your life, with nothing other than an ED visit in the hospital records. Or, if you prefer, you can get on with calmly, rationally mixing your hemlock smoothie or eating your 235 grains of Trepanazine.

And if that was your ultimate goal, then having a psych hold in your medical records is pretty inconsequential, wouldn't you agree?

Why would you care? You're dead, after all.

 

 

 

  • Sean Murphy

    Very well stated AD. Involving the police/EMT/Government agents in any other form, is usualy detrimental to acomplishing your goal, be it running business, restoring your stolen property, preventing violence, or ending your own life. There are situations in which even a dedicated anarchist like myself will call state agent though. Mostly those requireing the imeediate attention of specialists in a field that has been coersivly monopolized by the state. Medical trauma or fire spring to mind. There are private EMT services, but the level of regulation, and the legal liability imposed by the monopoly court system makes them little different from a state service, at least in terms of how they respond to suicide.

  • aaron

    [quote]If that makes me a moral coward in your eyes, then so be it. Your opinion of me doesn’t cost me much sleep.[/quote]

    It does.  Hopefully that will comfort you when we actually do slide into full-on socialism.

    [quote]Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.[/quote]

    Yep–the government makes a lot of money off us.  You’re threatening to take your productivity away.  That is not allowed.  So you will be handcuffed, taken to ‘psychiatrists’ , and given drugs to think the way we want you to.  Er…I mean ‘normally’.

    What’s the difference between threatening “If you do $x, I’m going to kill myself” verses “If you kick in my door at 3 AM, I will shoot you?”

    [quote]Youdo have a right to self-determination. Just don’t get me or my livelihood entangled in it by threatening first.[/quote]

    And how many of these people actually call 911 verses someone else calling ‘on their behalf’ and having the situation thrust upon them against their will?

    [quote]It isn’t a “line of work” for me. It’s who I am.[/quote]

    If you are so wrapped up in what you do that it defines who you are–what happens if you get fired?  What happens if you injure your back and can’t be a paramedic anymore?  Will you be so distraught you’ll say something stupid like “If I can’t be a paramedic, I’d rather be dead”?  I hope you don’t say it too loud.  The state might be listening.

    • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

      “If you are so wrapped up in what you do that it defines who you are–what happens if you get fired?”

      The problem is that it isn’t just losing a job. Deciding to simply not take a patient with suicidal ideations to the hospital who does commit suicide could easily lead to professional consequences at the licensure level (i.e. find another field entirely, not just another job), civil consequences (malpractice isn’t just for physicians), and depending on the circumstances, an argument could be made for involuntary manslaughter (‘unlawful killing without malice.. in the commission of a lawful act … without due caution and
      circumspection.’ California Penal Code 192. Other state laws may vary).

      Due to limited resources, training, and scope of practice, EMS is rather limited. Tell your primary care physician that feel like dying and your physician is likely going to ask about your plan before deciding to write a hold or not. However the physician can also prescribe therapy, medication and partner with the patient to provide a safety net in case the patient’s condition worsens. All things which EMS can’t do, hence magic words results in a trip to a local ED.

      Granted, the patient doesn’t, and shouldn’t, lose all rights. The patient should still be allowed to decide which hospital to go to, within reason (and please, don’t take the hospital social worker who is distraught because she broke up with her boyfriend to the hospital she works at) and decide whether leather bracelets are applied, but the choice not to go is no longer present.

      • http://www.ambulancedriverfiles.com Ambulance Driver

        If I get fired, I find another job as a medic somewhere else.

        Unless, of course, I get professionally censured as well.

        You know, like for allowing a suicidal person to kill himself.

    • Bobball

       Geez Aaron, where to start? I sincerely believe that any appreciable swing into “full-on socialism” will swing back the other way eventually. Why? Because people won’t like it either. Things would be far better balanced and left alone if all the extremists (from right and left) would just STFU and listen for a change. The world is not black and white. Trying to make it so only serves to screw everyone else.

      Threatening suicide is essentially extortion. I’m with Kelly 100% on this. There’s a great way to not have the police, EMS, hospitals and mental health organizations involved in one’s suicidal ideation. Don’t tell anyone…just go do it and be done. The folks who are threatening put everyone else in an awkward spot. Like it or not, “honoring” someone’s threat and leaving them will more likely ruin the cop/medic’s life than the person who threatened suicide. If they were serious, they’ll be dead. The cop or medic will instead likely be jobless and expected to somehow pay restitution to the family of the deceased for “not doing enough”. Right to die is fine. Right to threaten to die…no, at best, it’s bad manners.

      As for people not calling 911, but threatening to others…that’s beyond rude. Frankly, I find that criminal. How dare someone be selfish enough to mess up my rights and life as a human by calling me and putting that burden on me (friend or family or not), and not expect me to try and stop them. Perhaps people threatening suicide should call strangers with a blocked phone number instead. Still incredibly rude…but hey, they can talk and mind-screw someone, and we in EMS won’t have to get involved.

      Give it a rest, pally.

    • Kristopher

       Bullshit.

      If someone wants to kill themselves they can just buy a garbage bag, a nitrogen tank, some hose, and an elastic hair band, and go quietly play Spaceman Spiff in the bathroom.

      They are calling 911, friends, or relatives because they are little attention whores.

      They will get plenty of bad attention very quickly.

      If you want to own your own body, then fucking well own it. Don’t expect emergency staff to hold your hand when you threaten to do stupid things, and don’t expect them to eat a lawsuit from your relatives ( who absolutely will sue them, you fucking dumbass! ) to protect their right to be stupid.

    • Ambulance_Driver

      So I’m a moral coward and contributing to the slide into full-on socialism.

      Gotcha.

      Nice to know that you checked hysteria at the door and wore your Reason Hat, Aaron.

      You know who you sound like? The standard Brady or VPC troll, that’s who; every bit as strident and unyielding in your rhetoric as they are.

      And every bit as wrong and delusional.

      • Aaron

        You definitely aren’t justifying your position with logic and reason–I guess if you don’t have a better argument than saying I’m delusional, comparing me with a troll, and using sarcasm to imply that I’m hysterical.

        I’ve been reading your posts for a few months now and I got the impression that you understood governments will continually get worse and continue to erode our rights and individual liberties.

        How does that happen?  Using the second amendment as an example, first it starts with doing things with good intentions–like let’s ‘license’ gun owners.  Then it’s not allowing people the government determines to be ‘unstable’ to not have guns.  (Yeah–that does sound like a good idea)  Then they expand on what they consider ‘unstable’–maybe returning vets, Christians, and people that display the Gadsden flag.  And a majority of people will agree with them–because ‘those guys are crazy’.

        Now you can’t have a gun in a vehicle in most states.  You can’t carry into any government facility.  They are banned in a lot of state and local parks.  (Heck–a city near where I live, the mayor says “I don’t care what the state law says, you will be arrested if you carry in our parks”.)

        So where do you draw the line?  To draw a bad analogy, it’s more like a dike.  You poke one well-meaning hole in it, and the water starts to flow.  As it continues to erode, you go from a small stream to a gushing torrent.  Eventually the dike fails catastrophically.

        You are trying to argue that your slight widening isn’t really responsible for the failure because lots of other people are widening it as well.  When is the best time to stop the leak?  It’s before someone even pokes the hole.

        To bring this home to a more concrete example, I’ve had a conversation with my wife–that if I ever come down with a terminal disease (like cander) and I’m ‘beyond help’, I’m going to end it on my terms–and I should be allowed to do that because no one else owns my body and life.

        Now let’s say she (or someone else) decides to call 911 on my ‘behalf’.  Suddenly the state is thrust upon me through no action of my own and with out my consent.  Tell me why you should be allowed to violate my rights just because you are ‘doing your job’?  Yes–you could get sued for walking away.  I’m not claiming our legal system is perfect either–but that’s a different topic.

        • Ambulance_Driver

          I’m justifying my actions according to the Baker Act, which legally requires me to transport those people who, by word or deed, demonstrate an immediate threat of harm to themselves or others.
          If that’s not logical and reasonable enough for you, I can’t help you. I don’t get to pick and choose what laws I obey, no matter how you’d like me to.
          And yes, if you think me fulfilling my legal duty under that act contributes to our “slide into socialism,” that is indeed hysteria.

          • Aaron

            Once again, I disagree.  First off, I’ve already stated you have no right to my (or anyone elses) person but your own.  So who cares if they are an ‘immediate threat’ to themselves.

            Second, you say they are a threat to ‘others’.  Really?  Prove it.

            If I came down with cancer and decided to kill myself is that so ‘mentally unstable’ a thing that I could easily make the jump to killing myself by hijacking a schoolbus full of children and driving it off a cliff?

            Sure, there are mentally deranged people who could actually do that–but taking away everyone’s personal freedom because there are a few bad apples would be like shutting down a highway because a bank robber might use it to get away.  Or controlling guns because criminals might use them.  Maybe we should fire all the police officers because ‘a few bad apples’ keep violating civil rights.I could care less about the Baker Act.  I know nothing about it other than it sounds like another ‘law’ created by a bunch of idiots in some governmental role that think they are allowed to control.  That doesn’t suddenly give you magical power over anyone.It simply means you have the ‘blessing’ of the government to violate the rights of individuals.  Who cares are their blessing?  And you attempt to justify yourself by saying you don’t get to “pick and choose what laws [you] obey”.That’s exactly what you get to do.  If the government tomorrow said “We’re coming for all guns because they are ‘dangerous’” are you telling me you would smile and hand them over?  If they said “You can’t call Obama a doofus”, would you suddenly be silent?  How about if they said you must quarter soldiers in your home or stop blogging because there’s no ‘freedom of the press’ anymore?  Would you really go away silently?  Or would you choose to act civilly disobedient?  Would you resist?  Would you fight back?  What line must they cross before you suddenly say “that’s enough” and take your ‘kid gloves’ off.Which brings us full-circle back to the original issue.  If you don’t get to pick and choose and you required to blindly follow orders and laws, how does that make you ANY different from the Nazis who were also blindly following orders?  The Nuremberg Trials showed you can’t rely on the ‘following orders’ defense. Granted, your current actions don’t equate to shoveling Jews into ovens, but your reasoning that brings you to be able to blindly follow orders with no thought and great indifference to the rights of an individual is a scary thing.  And no good will come of it.  The questions are: where will you draw the line, and once you’ve drawn it, will it be too late to hold your ground.

            I had a friend once call me and say he was going to jump off a bridge.  I said “You’re a man, right?”  ”Yeah” he replied.  ”Then quit whining and just do it.”  And I put the phone down.

            He didn’t do it.

            You know as well as I that *most* of these are bullshit calls.  The people who really want to kill themselves actually just do it.  So why feed do you feel the need to obey the state and incarcerate a person against their will (with significant expense to taxpayers and/or the individual) because they are being a drama queen?

          • http://profiles.google.com/erniemedic Ernie Sharp

             Until you get a law passed that insulates me from going to jail or being sued for everything I own because I don’t take a suicidal person to the hospital, you are blowing hot air.
            As soon as you tell someone that you want to commit suicide, you create an obligation on that person’s part to care for you. In other words, you made it my problem. Whether you like it or not, that is the law. Until that law is changed, I am taking them to the hospital.

          • Ambulance_Driver

            Aaron is very principled, as long as the guy at risk is somebody else.
            Why, he’s a grown man without a driver’s license, he’s so principled!

            Kelly Grayson

          • Aaron

            No–I’m at risk every day.  When I get stopped, some police officers are nice and understand the law–others get pissed.  And you have to remember that the ones that get pissed carry guns and are allowed to shoot you without provocation or fear of retribution.

            And you still haven’t answered my logical arguments–just more sarcastic comments.

            Anyways–thanks for the debate, I’m done here.

          • Rogue Medic

            Aaron,

            Do the police get away with killing people at any higher rate than everyone else?

          • Matt Radcliffe

             Maybe he is from Seattle. Take a look at the woodcarver shooting.

          • Ambulance_Driver

            The increasing militarization of the police worries me.

            Mostly it’s the younger cops I see that have the “us vs them” mentality. In my experience, the older, more experienced cops have better problem-solving and communications skills, and come off as less authoritarian.

          • Matt Radcliffe

            How thin will these replies get? That i sometimes the case but I have seen in seattle that the younger police are more openminded when dealing with racial minorities. 

          • http://roguemedic.com/ Rogue Medic

            How does one single case of a police officer not being charged have anythingto do with whether this is more common with police than with civilians. 

            How many civilians unjustifiably kill people and are not charged?

            That single exampleis just a meaningless anecdote.

          • Aaron

            There is no such law that insulates you from going to jail or being sued.  In this country, anyone can sue anyone for any reason.  It’s up to juries to throw out the crap suits.

            It’s good to know that your fear of being sued leads you to imprisoning someone against their will.

          • Matt Radcliffe

             The law may be highly incentive but it is not justification. Moral and legal justification is separate.

        • Michael S

          “To draw a bad analogy, it’s more like a dike.  You poke one well-meaning hole in it, and the water starts to flow. ”

        • Michael S

          “To draw a bad analogy, it’s more like a dike.  You poke one well-meaning hole in it, and the water starts to flow.”
          A very bad analogy.  If you really want to apply it to this situation, a liberty-loving EMT who obeys the law in question isn’t a guy drilling another hole in the dike; that hole was drilled by the state when the law was passed.  He’s–I dunno…  He’s a guy who wants to fish out the folks who are drowning, but the snipers up on the dam will only let him do it if he doesn’t interfere with the water coming through the hole.  

          Ideologically, I’m about as hardcore a libertarian as you can get.  But we live in the Real World we live in, and there many, many times when that world requires us to do wrong if we want to interact with it. You can say “all wrongs are equally wrong, so obeying the Baker act is just like exterminating Jews,” or you can accept that not all wrongs are equal, and that good people strike the best balance they can.  

          Of course I’d rather live in Libertarian Utopia, where nobody’s ever forced to make those compromises.  But if it’s possible to get there, we ain’t gonna get there by ignoring the current shape of the world.  You gotta make compromises to live in this world, make compromises to change it, or withdraw from it to stay ideologically pure.  Not everybody thinks the last option is best.  

        • Kristopher

          Aaron:

          Your use of State funded roads is an initiation of force against me. Your mere conveneince at being able to make a living or buy food does not excuse that. You should also stop using water, power, or sewers, since these are either state agencies, or are state granted utility monopolies.

          If you have ever voted, you have definitely initiated the use of force against me. I disagree with all of your vote choices, and are therefor your victim.

          If you hold a motor-vehicle operator’s permit, you are supporting another form of initiation of force against me because of your own cowardice vs. the highway patrol.

          Am I starting to sound ridiculous yet?

          • Aaron

            The state has quashed most private roads, and I am forced by the state and my employer to pay taxes.  Fuel is even taxed for my use of the roads.  I don’t see how traveling down a street initiates force against you.

            I have my own well which I pay for, and my own septic system.  While I still rely on power (I have no clue who actually runs my local power company), I have no other option as the government does not allow competition in that space.  They also won’t let me mow down an acre of trees to put of a solar farm.  Once again–not an action by me, but the government.

            I also don’t vote.  I am not going to pick one ‘ruler’ over another.  I choose none.

            I don’t have a drivers license or permit.  The government doesn’t ‘permit’ me to freely travel.  What part of the fourth amendment don’t you understand?  That no one shall be deprived of life, liberty (freedom–including freedom of movement), or property without due process of law.

            Lastly, inaction does not ‘initiation of force’.  I did have a drivers license previously, but that has no bearing on the highway patrol using force on you.  An individual is allowed contract freely (like getting a license from the state).  That’s one of the basic principals of our legal system.

            So yeah–you do sound ridiculous.

          • Mpatk

            Aaron,

            You DO have a choice with regards to power and roads: don’t use them! By using them, you are tacitly supporting the government’s monopoly and or enforcement of a monopoly.

            In case you’re wondering the point, it is EXACTLY equivalent for us to demand that you suffer the consequences of no electricity as it is for you to demand that we violate the law and get fired/sued/arrested. So until you’ve got e guts to practice what you preach and go without electricity/roads, stop telling us that we’re cowards for not POINTLESSLY defying authority.

            Oh, to add to that. You’ve heard of “picking your battles”? If you read what AD and others have said (past the ZOMG NAZI reaction), you’d see that we do NOT blindly take people into custody;and that we DO use our influence to avoid taking rational people who are victimized by “shady 911 callers”.

          • Kristopher

            Who said this was about me?

            You demand we put ourselves at great risk to defy the State on this matter. And yet you refuse to defy the State yourself on this electricity and road using business.

            I’m sorry.

            I didn’t realize that you were so ideologically blinkered that you couldn’t see the obvious without being hit with a 2 x 4.

        • Kristopher

          “Yes–you could get sued for walking away.  I’m not claiming our legal system is perfect either–but that’s a different topic.”

          Are you going to set up a trust fund to compensate medical professionals for the resulting suit and loss of income due to state sanctions if your wife decides to sue?

          No?

          Than you should have kept your mouth shut about your plans. If you are going to break a law in your state, then running your mouth is really stupid.

        • http://www.jbontherocks.blogspot.com/ JB on the Rocks


          Yes–you could get sued for walking away.  I’m not claiming our legal system is perfect either–but that’s a different topic.”

          No, sir, that IS the topic.  Unless, of course, you and your ilk are publicly stating that you’re going to take AD’s place in prison and pay his legal fees and provide for his daughter when all his wages are garnished from now until he takes the big dirt nap….

          As a now retired paramedic, I would GLADLY leave the “Oh, woe is me… my life sucks, I’m going to kill myself… hey is that a new episode of Glee?” people at home alone *IF* you can find a way to make me absolutely 100% completely totally protected from ANY and ALL legal actions against me for my acts or lack thereof.  

          In other words: As long as you give up your right to sue me for anything I do, I’m willing to do whatever the hell you want me to do.  But as long as you’ve got the right to pursue legal action against me, I’m going to take you to the hospital when you call 9-1-1 after scratching your wrists.  

          After all, I don’t think I’ve ever had a plaintiff complain “If that paramedic hadn’t done what he did, I’d be dead by now, so let’s sue his ass!!”

          YMMV. 

          • Aaron

            [quote]Unless, of course, you and your ilk are publicly stating that you’re going to take AD’s place in prison and pay his legal fees and provide for his daughter when all his wages are garnished from now until he takes the big dirt nap….[/quote]

            Right–I forgot that he and the rest of the government are allowed to violate my rights because some of them have daughters or a mortgage to pay.

            It would suck to go to jail, but I’ll be damned if I’m going to violate someone elses rights just to save my own ass.

          • Bobball

             Aaron…that’s pretty big talk. Kelly isn’t part of the government. Nor am I. Nor are many (most?) EMS workers. However, in our roles in public health and welfare, we are expected to obey the laws set forth for us.

            Now, that doesn’t mean that we don’t have the opportunity to try and effect change as appropriate (I don’t think allowing those threatening suicide to not be brought to the hospital is one of them, but that’s me). Still, we can try to change the law, but until then, we are expected (rightfully so) to obey it.

            Our society (you can choose to say you’re not part of it, but as long as you’re coexisting among the rest of us, that’s just your own little fantasy) has decided that those who pose a danger to themselves or others must be cared for, to ensure that in a state where they may harm themselves or someone else, that they’re prevented from doing so…at least until someone with the appropriate education and tools can ensure that the person is capable of making such decisions in a rational manner. It’s not for us to decide, given the lack of education (measured in years) and tools to make that determination.

            You speak of others’ “rights”. So, if someone is a danger to others, should I leave them alone and let them go about their business? In such a case, I’m acquiescing to their “right” to be left alone, only to facilitate them violating the rights of someone else.

            As for self-harm…I’d rather delay their right to harm themselves to ensure that we’re not letting someone (who may not at the moment have the capacity to make rational decisions) inappropriately deny themselves their right to life (among others).

            Again…people kill themselves every day. If someone is pressed to do so, fine. However, don’t call 911 or call someone that you don’t know for sure *won’t* call on your behalf.

            Your previous straw-man argument about doing yourself in if you have cancer is just that. I’m assuming your wife is ok with your decision…or if she’s not, that you’ve recognized that issue and when (or if) you do get cancer, you won’t bug her about it and say, “Honey, can you get me my .00 Buck shell? The one with the smiley face on it?” Instead, you’ll quietly go off somewhere and take care of business…preferably where she won’t have to clean up after you…or find you…or find bits of you later. And if she is cool with it, she won’t bother calling us. On the other hand, if you haven’t told your neighbor, and he stops by and you say, “Can you come back later? I’m just nipping off to kill myself”…well, don’t be surprised if your interrupted. See, your right of self-determination doesn’t give you the right to put a potentially negative burden on someone else.

            I had that conversation with my dad when he was diagnosed with terminal lung cancer. He chose not to kill himself, letting the cancer do that instead…but toward the end, the 50ml bottle of morphine (one good drink would pretty much put someone down quick) was by his nightstand. He could’ve chosen it at any time. But he was also man enough that he wouldn’t have called any of us kids before he did it…he would’ve put himself to sleep and we would’ve found him dead. But again, while he was not in dire straits, he made his wishes very clear to all of us.

            Guess I’m done. I kinda wish this was an old newsgroup versus a blog comment area…then *Plonk” would mean something.

          • http://www.jbontherocks.blogspot.com/ JB on the Rocks


            I kinda wish this was an old newsgroup versus a blog comment area…then *Plonk” would mean something.”

            I knew what it meant. 

          • http://www.jbontherocks.blogspot.com/ JB on the Rocks

            No, nobody said that.  I’m not sure if you’re missing the point, or just ignoring it.  I’ll give you the benefit of the doubt, and restate my case:  The legislature, full of duly elected representatives selected by the people, has enacted certain laws, and AD (and the rest of us EMTs and paramedics) have taken an oath to abide by those laws when we perform our duties.  As such, when AD takes a person who has threatened suicide to the hospital against their will, he is simply following the law.  

            If, Aaron, you suggest that he is better off violating the law and give up his livelihood simply because you believe he should uphold YOUR rights, then you, sir, are the single most selfish man I’ve ever met.  

          • Ambulance_Driver

            Aaron is very principled… as long as it’s someone else taking the risk.
            Kelly Grayson

  • David Neylon

    To me ending your life is your right.  If you really wanted to kill yourself just do it.   Threatening to end your life is a cry for help and by publicly announcing it you’re going to get the help.  Whether or not it actually helps is something else.

    AD is required by duty AND the law to transport such a person against their will.  If you don’t like it tough.  Next time just do it.  And remember, it’s down the river not across.

    Oh and for any of you bleeding hearts out there that decry my lack of sympathy and feel that I don’t understand the damage that is caused to a family of a suicide?  Go fuck yourselves.  My father killed himself when I was four and my youngest brother was 9 months old.  Don’t even start to tell me I don’t understand.

  • http://www.facebook.com/profile.php?id=1490494722 Mike Phillips

    Well said, AD.  Those two guys obviously just don’t ‘get it’.

  • http://www.jbontherocks.blogspot.com/ JB on the Rocks

    I’m sure that, facing criminal AND civil legal action, as well as loosing his job, his income, his ability to provide for his family, and a thousand sleepless nights, TJIC would remain a stead-fast bastion of personal freedom and refuse to take the same actions that you did, AD.  

    Yrro and Roberta nailed it.  Bravo, both.  

    • Ambulance_Driver

       Well, he did lose all his guns and his approval by the state to own them, based on his blog comments, so I guess he did.

      I think he was denied due process in that matter, and I’m sympathetic to his cause.

      Then again, if his approach to the Arlington PD was anything like his behavior on my blog, then I can see why it happened.

  • http://profiles.google.com/erniemedic Ernie Sharp

    I have had the discussion of transporting people against their expressed refusal countless times before, and I have been called a ‘jackbooted thug’ for taking your position.

    A man has cut his wrists with a knife in an apparently unsuccessful attempt to take his own life, but refuses to go to the hospital. Are you seriously proposing that I leave you there? Then what happens when I do
    so, and you are killed? Only this time, you used a gun and took your wife and children with you?

    How about the man that I ran on last week who was intoxicated and hit a telephone pole in his truck. He had a large bump on the head and was acting confused? He didn’t want to go to the hospital. Is he confused
    because of the alcohol, or the blow to the head? Do I leave him there because he refused? What if he dies as a result of a head injury, and his lawyer can show that he was not intoxicated, just confused from brain damage?

    I go to your home, and you have deep lacerations on your wrists that are consistent with a suicide attempt, and you tell me that you did it because the voices in your head told you to, I absolutely will Baker Act you.

    If your girlfriend calls and tells me you tried to commit suicide because the two of you got in a fight, I probably won’t, unless I also find an empty pill bottle that should still have 30 pills in it because it was prescribed yesterday.

    This sort of thing isn’t done because you won’t go to the hospital for the flu. I have to have a reasonable belief that you are an active harm to yourself or others.

    I tell you what: I will never again take anyone to the hospital against their will, if the law is changed to make me immune from legal liability if I accept a refusal from a person, and they die, even if it turns out that they were mentally incapacitated at the time I accepted the refusal. You see, as long as you keep the law the way it is, what it boils down to is this: You want to be able to refuse care, and still hold others liable when your decision turns out to be a poor one.

    OK, how about as a thought exercise, I give you a few examples, and you tell me what you think you would do as the paramedic on scene:

    A motorcycle rider is in an accident, and is not wearing a helmet. He takes a blow to the head and is dazed and confused. He does not want to go to the hospital and threatens violence if you try. Do you accept his refusal?

    A 16 year old teen is in a car accident. He has an obviously broken arm, but does not want to go to the hospital. Do you accept his refusal?

    A man is intoxicated and gets in a fight. He does not remember what day it is, nor does he know the name of the city he is in. He is refusing care. Do you accept his refusal?

    In each of those real life cases, the person is not legally able to refuse medical care because of altered mental status or because they are a minor. The law REQUIRES you to treat them, and the medic who does not is civilly and criminally liable if they do not. If you accept refusals from any of the above, you can lose your license, go to jail, and be sued for everything you own.

  • LL

    I’m not going to read all the crazy because I already had indigestion right now from having spicy Popeye’s chicken, but might I say, their arguments ONLY hold true if any and all family members lose their right to sue because you “didn’t do your job.”  Yeah, none of those people can guarantee that sobbing mommy can’t accept that they slit their own wrists and so it would be YOUR fault for “letting them go,” and therefore, they get to take your home and all property in a negligence suit.  I’m libertarian, you know that, and I actually understand and agree with the THEORETICAL point of having free choice to kill yourself.  But in the end, if you call someone else who has some sort of responsibility to DO SOMETHING and it leaves them open to all kinds of liability, fuck your freedoms on that one.  By the way, if you’re crying about how you want to kill yourself, call your buddy instead.  I’ve been in that position, getting that call, and it is the SCARIEST THING EVER to try to figure out what to do and if he had gone through with it…oh lord, the guilt, I can just imagine.  See, normal people feel a moral obligation to try to help people like that.

    Ugh.

     

  • jer

    I have a serious problem with your “jack booted nazi” butt. You’re a bad speller. *eSpecially.

  • Foo

    Kelly, I’d be entirely with you (within the limits of statistical error) if it weren’t for the last few comments: “And once you’re home, you can go on about your life, with nothing other than an ED visit in the hospital records.”  If only it were so simple.  
     - Your state may not view that ED visit as a big deal, but in a number of states it’s a lifetime or 5-year prohibition on firearms ownership.
     - It’s a required disclosure on US Federal clearance paperwork.
     - etc.

    Calling 911 on somebody for mental health reasons is right up there with calling CPS on somebody.

    • Ambulance_Driver

      Not necessarily.

      It’s my understanding that it will only appear as an ED visit, which is as non-discoverable when it comes to your gun rights as an ED visit for any other reason.
      It’s only when a PEC is issued that some states may take away your firearms rights away.
      And no, I don’t agree with that, either.

      • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

         It really depends on the state. In California, the 72 hour hold (Welfare and Institutions code 5150) can be written by police officers, designated evaluation teams, and physicians and it comes with a 5 year state ban that can be appealed. The 14 day hold (WIC 5250) requires a court order, and because it comes with a court order it triggers the Federal ownership ban.

        This is also one of the reasons I go slightly crazy when people talk about abusing 5150 orders for drunks or other patients who simply want to refuse care. 5150s are for mental illness only. If the patient isn’t a danger to self, others, or “gravely disabled” due to a mental condition than merely mentioning the term 5150 deserves a smack down.

        • Ambulance_Driver

          Indeed.

      • Foo

        California’s WIC5150, as Joe noted, is a 5 year prohibition.  Per [J Am Acad Psychiatry Law 35:3:330-338 (September 2007)]: “In the District of Columbia, Hawaii, Illinois, Maryland, and Oklahoma, [...] voluntary treatment can be enough to trigger a [permanent] prohibition.”  (Certainly including involuntary treatment, however brief.)

        DoD Form SF-86 requires disclosure of (essentially) any mental health encounter in the last 7 years; answering untruthfully is, of course, a felony itself.

      • Emrys Landivar

        “Not necessarily.”

        Um, yes it is.
        Its not just gun rights, its a host of rights and issues.  You shouldn’t call the cops on your family members, especially if they are suicidal.

        • Ambulance_Driver

          Sorry, but that’s your opinion, not necessarily fact.

          And I even agree with your sentiment, but sometimes the police and EMS are the only means of getting your loved one to the help they need.
          It’s a damned blunt instrument, as Roberta said, but don’t blame the instruments.
          Kelly Grayson

      • Bobball

         Exactly. In my state (MN), the “Emergency Request for Admission” (also known as a transport hold) can be signed by police or a physician. It only compels transport to a facility for evaluation (to the ED in our daily operations). It only becomes a matter of the courts (and therefore potentially something that could screw up a permit to purchase, or probably even carry) if the physician agrees that you must be dealt with from a commitment perspective. I’m not even sure the 72 hour holds used in the hospital are an issue if they don’t pursue further commitment.

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  • CajunMedic

    I don’t know what fantasy world TJIC lives or works in, but it ain’t the great state of Louisiana. Where mental health care is deficient and there is a lawyer on every commercial break and billboard; ready to destroy you economically at the drop of a hat. I hate having to take the ones in that were making the hollow threat in the heat of the moment and really didn’t mean it (I know, I’m not really qualified to make that decision, but we can pick those out fairly easily) but the Schizophrenic clearly off their meds but is A&O enough to refuse, I can’t do anything with other than “I can’t force them, you’ll have to call the coroner on Monday”

    • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

      Since when did orientation level determine that a patient has capacity to make decisions? A/O x 4 is a part, but not the sole determinant, in shifting between informed consent and implied consent. 

      • Ambulance_Driver

        Because we EMT types have very fuzzy understanding of present mental capacity, and most of the time we say “AAOx4″ as if that meant something tangible and legally defensible.
        It doesn’t, but some of us are working on encouraging more precise language and better documentation.
        I’d give him a pass on the industry jargon, as I think we knew what he meant.
        Kelly Grayson

        • http://profiles.google.com/erniemedic Ernie Sharp

           I don’t know about that. Many think that A/Ox4 means competent to refuse. I once got into a heated argument with a room full of medics, who were claiming that you can take a refusal from a person who was unconscious until you gave them narcan, because at the time of the refusal, the narcan made them competent to refuse.

          • Ambulance_Driver

            Good point.

            What I meant to say was that a great many EMT’s use “AAOx4″ as an interchangeable term for “present mental capacity.”
            Which we both know it isn’t.

          • CajunMedic

            Slap my hand, you guys are right about the use of A&O. I stopped using it in my run reports, I now document “Conscious, alert, and oriented to person, place, time, and events leading up to EMS contact”.
            - Here’s the particular case I was referring to in the second part of my statement, I’ll sanitize the best I can for privacy concerns: 50ish female, just been d/c’d from impatient psych care after a 14 day PEC. for suicidal ideations. Family called because she was “acting strangely”. We get there, she’s walking around talking to her family, the Sheriff’s Deputies, and us. She’d vacillate between absolute lucid thoughts (who we were, who her family was, what meds she takes, etc.) and accusing her husband of trying to kill her, Black helicopters coming to take her away, etc. She had the manic hand gestures and rambling speech. (the nurse at the hospital called it “flight of thought”. I explained it the best I could to her-she was with it enough to understand informed consent, but not enough I could I could force her under implied consent. Her family tried everything they could, she gave in and let me check her blood sugar (IDDM). My partner, LEO’s, FD, family, tried their best to convince her to go. I called med control and explained the situation- no orders for sedation and they won’t order transport against the patient’s will. After about 1.5 hours on scene, SO had gotten ahold of the Parish Coroner on a Sunday afternoon and did a PEC over the phone. A Deputy picked it up and met us at the hospital. The patient was transported by SO and we followed. What do you think?

            -Ernie Sharp makes a really good point. I’ve worked with those kinds of medics- Scary. On a similar note- what about “catch and release” diabetics?

          • http://profiles.google.com/erniemedic Ernie Sharp

             I have done that for diabetics, with one caveat: Remember that the D50 is short acting, and the BGL will be low again in a few minutes. So the only way I will do catch and release is:
            1 The patient has been a diagnosed diabetic for a year or more.
            2 The patient has a caretaker present to watch them.
            3 They will eat a meal within the next 15 minutes. The term ‘meal’ does not include salad, or any other food with low glycemic impact.

            I have been known to make a diabetic a sandwich or cook a small meal in a diabetic’s house to do a ‘catch and release’

          • Ambulance_Driver

            Same here. I have no qualms at all doing catch and release diabetics, provided Ernie’s conditions are met.
            Kelly Grayson

          • Bobball

             Catch & Release diabetics are different from opiate ODs as a rule. If nothing else, the short half-life of D50 can be bolstered by food. The short half-life of naloxone…not so much.

            Our system’s protocols actually require the following (or we need to talk to a doc to get the ok). Overall I’m ok with it:

            1) No long-acting insulin or oral hypoglycemics…the docs are more nervous on these as the orals have a different action that should not normally cause acute hypoglycemia…or the half-life may be long enough to not survive D50 and a meal. So, for those we chat. Some are left, some go.

            2) An identifiable cause of said hypoglycemia (overexertion, missed a meal/snack, etc.).

            3) Food present and patient able to eat. As a rule, I always make/made sure the patient was well into their meal before I called a doc in the old days, and do the same now before I think about having them sign.

            4) They need to have someone responsible with them (we’re not specific on time…but most of our folks are looking at 8 hours or so).

            5) They need to agree to follow up with their MD

            6) and of course, they need to have a return to being alert and oriented and a normal (or somewhat higher) glucose.

        • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

           I like to still think I’m an EMT type… even if my NREMT cert is no longer active. :’-(

          …but seriously, I made the comment because I’ve seen enough people, both online as well as partners, think that A/Ox4=refusal. It’s near the top of things that grinds my gears along with the indication of c-spine being “trauma” and the indication for a NRB being “ambulance.”

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  • http://www.twowheeledmadwoman.blogspot.in/ Roberta X

    I’m seein’ some hypotheticals here — and in other comments (TJIC, I AM talking to you, among others) that are pure-dee BS.

         Lets step back and state terms: AD was talking about those situations in which a person has invoked Leviathan: called the ambulance or the cops; called 9-1-1.  And they are threatening to do themselves in.

         Problem one, you either called the State/Its Agents or you behaved so incautiously as to get someone else to call.  Why you do that? 

         Do you have any idea how easy it is to die?  –And how easy it is to flinch?  Or how plain foolish it is to announce your intention to anyone you cannot trust to answer, “Okay, what should I do about your cat?”

         I’m calling you out.  I’ve been there, teen-ager in the bathtub with an oh-so-tempting razor blade and a series of oh-I-wanna-ow-that-hurts marks, time and again; I’ve been there, a heartbroken grown-up, observing that when the light is right, you can see your ticket out sitting in the chamber and it’s only going to take a little more pressure–

         I chickened out.  Or I got brave and decided I could live through the mess-of-the-moment.  Whatever; but I have Been There and I don’t have to listen to airy theories about it, I know.  And I *didn’t* tell anybody — ‘cos I didn’t want to get stopped.

         We don’t live in Libertopia.  We live *here,* with the State a monster dozing underfoot.  Now you can live outside it, if you are stealthy enough; you can live on it, if you stay inside the lines; some folks can even weave back and forth — but you *can’t* wake the beast up and *then* run in circles, screeching, “It’s oppressing me!  It’s oppressing me!” and expect a good outcome.

         It happens even if you wake up the damned thing innocently; it happened to TJIC, which is why this is in his wheelhouse.

         But it’s a long, hard slog before the State is rolled back far enough to fix that and it cannot be done on the State’s turf with the State’s tools.

         In the meantime, if you’re gonna kill yourself, go do it (or go look oblivion in the face and blink, there’s no shame in that); if you’re all down and blue, ‘scope you out a head-candler who doesn’t panic easy and talk it out.  (I did that, a few years back — there’s a hotshot local gunnie who happens to do that sort of work in his day job; and he works for himself).  But don’t call up Johnny Law, or your local EMTs, or the Fire Department, and expect them to use any different tools than the same ones they use every day on your special snowflake self.  All they are allowed to use are hammers and once you’re brung them in, you’re just another nail.

  • Islandmedic1

    Man, I don’t know what I laughed harder at. This retort or the Vagina monologue…..

    But seriously folks, we work in a grey area. Hell, we epitomize the grey area at times. But I do know that I have a similar law in my response area, and it’s pretty black and white. I don’t agree with it, but at the same time, it’s not my opinion that really matters right now. People are going to say stuff that doesn’t make sense. I can’t remember who said it but we all have probably had the “You get drunk and say stupid things. Things you can’t take back.” conversation with somebody. Doesn’t mean we are bad people. And fascist, Nazi, rights trampling, jackbooted AD??? In the words of the Great Shwamee himself, Chris Bermann and the rest of the ESPN Sunday NFL Countdown guys, “Come on Man!!!” When you start throwing around those terms about anybody, you really show how small minded you really are.

    God I miss football…..Even with it’s fascist dictator Goodell!!

  • http://www.lifein3d.net/ Instinct

    TJIC and the others seem to be anarchist-lite.  They don’t want to set the world ablaze, but if it catches fire HOW DARE YOU DO ANYTHING ABOUT IT!!!11!!

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  • Geoffrey Horning

    First of all, better you than me…geez I’m glad nobody reads my blog…some of the people who read yours are just plain stupid…and we can’t fix that.  Second of all, if you were really a Nazi I’d drive the blues mobile through your parade on the bridge…I hate Louisiana Nazi’s…

  • http://www.barefootclown.net/ dave

    This is the difficult ground of libertarian philosophy.  It’s easy to apply the theories of self-ownership and self-determination to the sane, rational actor who is capable of caring for himself.  The idea starts to break down when the person involved isn’t rational, or isn’t capable.  The ultimate cold-hearted answer is “well, let him die in the back alley if he can’t hack it,” but I know very few people who would actually go that far.

    What do we do with the insane, the infirm, the infant?  I don’t have an answer, and I’ve been chewing on it for years.  Anything we do is a step off the path of self-determination into the garden of government control, and yet not doing something to address the reality that such people exist is just as foolhardy as giving the government total control.

    • http://twitter.com/tmoreau2 ILTim

      Somehow I think we have to acknowledge the choice, rather than impose submission universally.  Do you want to be ‘cared for’ and subject yourself to being the caregivers responsibility, or would you like to ‘opt-out’ at this time and take full and complete responsibility for yourself? 

      That call is being made automatically, using what seems to me a low-threshold, and the depth and breadth of force applied to the non-human after the decision point is phenomenal.  Its very much like being hit by a speeding train. 

      So as Roberta X says in another comment “or you behaved so incautiously as to get someone else to call”, I have to live ‘cautiously’. 

      To hell with that notion! 

      • Ambulance_Driver

        I’m perfectly okay with letting them walk away… If you find some way to shield me from civil and criminal liability.

      • Patrick

        Tim,

        The problem is that societally we’ve decided you need to be ‘competent’ to have that choice.  If you’re not competent, as in Dave’s insane, infirm and infant, society tries to ‘care’ in such a way that they preserve your FUTURE agency – that is, they don’t let anything irrevocable happen to you.  If today you’re drunk and angry, making threats, then you go dry out and calm down so that tomorrow when you wake up sober you’ll still wake up.  If today you have taken so much heroin you can’t open your eyes, you get oxygen (and narcan if your paramedic doesn’t like squeezing that bag), so that tomorrow when the drugs have run their course you’ll still wake up.  As so many commenters have said, there’s no effective prohibition against suicide, only a system that catches the flagrantly emotional or stupid.

      • Patrick

        And as far as living cautiously is concerned – this is part of living in any society.  Independent though you may be, if you are not also considerate of your neighbors/relatives/friends and their needs, the world goes Mad Max at speed, at least for you.  Roberta X isn’t saying you ought to love the State, she’s saying you ought to have the common decency not to guilt your friends into getting you locked up or risk the guilt that comes with inaction.  If you can’t act like an adult around other people, you either need to leave society or learn fast.

      • http://www.twowheeledmadwoman.blogspot.in/ Roberta X

         ILTim, we dance on a dragon’s back; we may not *like* the State (I loathe it.  I’m not too keen on Authority in general) but there is is, with armies, judges, policeman, senators, EMTs and endless busybodies with clipboards.

             It’d be nice to just tell them off, but they think that means “try harder.”  So you have to dodge them when you can and comply when you must.

             When I advise you to “live cautiously,” it’s just non-expert advice.  All I want you to do, all I would ask of you, is to lie in accordance with the zero-aggression principle.  (A golden rule some people would argue I break every time I vote.)

        • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

           That means “try harder?” Sorry, but if your of sound enough mind to be able to make your own decisions then I have no problem asking you to sign on the dotted line and leaving you alone. Heck, you don’t have to sign, there’s a procedure for that too. If you want to die of an MI in your bed because you don’t want to go to the hospital, then fine by me.

          The problem is, since we’re talking about psychatric holds, is that these people are not of sound mind. If you’re a schizophrenic walking around a train station trying to light someone on fire, you aren’t of sound mind. If you’re ODing on Tylenol because your BFF Jill broke up with you, you are not of sound mind. That’s a completely different situation than what is commonly found in patients with chronic diseases looking for euthanasia. If you have ALS and you’re now bed bound and barely able to move your head (see the PBS Frontline episode “The Suicide Tourist” for an example), then I definitely support you being able to actively end your suffering. That, however, is not representative of the average patient forced into treatment.

        • http://www.twowheeledmadwoman.blogspot.in/ Roberta X

           Ooo, Freud!  “All I want you to do, all I would ask of you, is to *lie* in accordance with the zero-aggression principle.”

               A typo, but srsly, when Mr./Ms. EMT asks, “Are you gonna hurt yourself?” you say NO, unless you want to go explain yourself to overworked head-candlers.  Most of them take “Yes” as evidence you’re not of sound mind — they’re not all Joe P.

               Is this right?  Is it how things should be?  That isn’t the question; the question is, how can you stay out of the rubber room and keep the State from being all up in your business.

      • mpatk

        Tim,

        It’ generally not a low threshold, neither EMS nor police like psych holds. I haven’t been doing this as long as AD, but I’ve done a lot of transfers of psych holds from EDs. I can’t remember a time where we took a police-ordered psych hold that wasn’t warranted by either someone deliberately seeking attention with their words/actions, or truly irrational behavior. The holds I disagreed with we’re either minors sent by their parents, or walk-in patients who got caught up in the involuntary hold (and I did my best to help those).

        Also, I don’t know where you’re getting the idea of violence from. I rarely have to use restraints (physical or sedative), and it’s only after someone has tried violence against me or another public safety person on scene.

  • NeedleNerd

    I agree with you AD. It is completely your choice to mutilate and mangle yourself… Up until you try/discuss doing it in front of me. We didn’t make the rules, we just have to play by them…

    And the whole Nazi thing was a bit much… That guy must have the portion of the brain that controls rationale thinking/logic/ability to have a conversation with the big kids portion of the brain in toilet….

    • Matt Radcliffe

       It is an inflammatory and overused comparison but it is the simplest one that comes to mind for people that say things like: “We didn’t make the rules, we just have to play by them…” and think that it removes their responsibility for their choices. You may be right, and you may be wrong but your actions are your own.

  • Duke

    It’s always smart to keep your mouth shut when talking to any officials and only say what is absolutely necessary.

  • jer

    Just finished reading some of TJIC’s tweets. And the government has a problem with Ted Nugent?

  • Snowdog

    It’s quite simple. If you don’t want to dance with the dragon, don’t wake it up.  Go off and kill yourself in private, don’t tell anyone. Second someone dials those three magic numbers, you’re going for a ride no matter if you want to or not. 

    • Matt Radcliffe

       The idea of getting help for a suicidal person that is an obvious danger to themselves but comments like:    [The]“Second someone dials those three magic numbers…” is what is frightening to me. Some people seem to have a problem grasping how easy that is to abuse. Safety and helping people is all good. Dragging someone off to get them help may be helpful. ANYTHING that allows a simple accusation to bypass any checks or balances or due process is a frightening idea.

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  • Paul B.

    My very first trip on a ship, I watched a jumper leap off the Verrezano Narrows Bridge in NY and try to spatter himself on our deck as we passed under it. He missed. The fall killed him anyhow, but he started screaming on his way down, which does make one wonder about any second-guesses.
              Behaviorally, its very possible to support our existing laws, as they reflect natural law to a surprisingly consistent extent. Since we’re dealing with hypotheticals in this discussion, for the most part, I find it abhorrant that someone would berate AD in these posts. Our behavioral codes, while making room for self-determination, act as a series of  if/then decision gates, and since all social laws are based on compromise (an averaging force, really), the laws related to life-and-death must account for behaviors that fall outside of normative behavior, and since behavioral decisions are so fluid, the potential for bad decisions (errors in the ‘if/then gates) must be mitigated.  Erring on the side of life in life-and-death decisions is, therefore, based on natural behavioral law, since you have to account for both the normatively-arrived decisions (to live, at any cost) AND second-guessed decision potential (the oh shit scream of the penitent jumper). Since most folks want to live through life-threatening circumstances, and since there’s a statistically dominant portion of tried-and-failed due to consequential reality when it comes to suicide, to take a hands-off approach would be both unnatural (at this point in our social norms), and illogical.
     

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  • Medic8023

    AMEN!!!!! If you don’t want us involved, DO THE JOB RIGHT THE FIRST TIME!!!! I am all for assisted suicide laws. I think everyone has the right to end their lives if they want to.. Just don’t involve EMS. Like it or not, we are bound by law to save you if you harm yourself..

    For all of you like TJIC, I have a question. If you see an armed robbery being committed, and you have ability to stop that, would you, or would you allow the victim to be pistol whipped or shot??

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  • Tim K

    As a strong libertarian (wookie suit optional) and an EMT-B, I have to agree with your above comments. 
    I think the most important thing for those fitting you for jackboots to remember is that we’re talking about someone who has drawn enough attention to themselves *without actually committing suicide* that EMS got called.
    If you’re really that determined to commit suicide, take a leaf out of the Nike booklet-  just do it.

  • http://www.facebook.com/profile.php?id=1073081262 Christopher Matthews

    So, I’m kind of wondering with the criminalizing of suicide, how do they enforce it? Do they put your corpse into a penitentiary? If you attempt it unsuccessfully, do you become a felon who isn’t allowed to own weapons? Do you lose your drivers’ license so you can’t legally drive a vehicle to your death (adding weight to the posthumous criminal charges)?

    • Rogue Medic

      Suicide is not being “criminalized.” The mental health laws are the relevant laws – not the criminal laws.

      .

  • Mike Voncannon

    I approach this from the LE side and I agree wholeheartedly with AD. If you say the magic word, you win a free trip. That its with him or me does not matter, you ARE going; walking if you wish, kicking and screaming if not. We aren’t going to risk our career on whether you were serious or not. That, as he said, is for professionals to decide.

    If anything, I wish the criteria to involuntarily take someone was looser. I encounter people who are past the edge of the map, but do not indicate that they are an immediate danger to themselves or others. That we can’t get them help is often frustrating; and in the Arizona case people have had to die before someone obviously in need of help was forced to get it.

  • http://twitter.com/tjic tjic

    > I guess I shouldn’t have taken my “I am TJIC” badge down off my blog, huh? 

    Didn’t realize you had. Thanks for having it up when it was up, and no worries at all about taking it down.

    > I mean, you get a bunch of individualists who are passionate about personal freedom and smaller government, people who are legitimately concerned about the encroachment of government on our personal freedoms, whose general approach to life is “You leave me along and I’ll leave you alone,” and invariably there is one in the bunch who says something so far out in friggin’ left field that the rest of them want to sidle away, eyeing him nervously all the while.

    Your argument here is basically “your stance is unpopular, therefore you shouldn’t say it”, right?

    Look, I’m not marching to town hall on the day that the League of Women Voters is having a meet the candidates tea, saying “Public roads are the mark of the devil!”. I’m addressing a bunch of conservatives and libertarians, saying “according to the principles you yourselves speak about, action X is illegitimate”.

    Further, I’m not even saying “Hey, ambulance driver, amusing post on what your nephew said at the mall…and also IT IS MORALLY ILLEGITIMATE TO PROVIDE EMT CARE!!!?!?!?!!”.

    No.  I spoke up only when you announced “Hey, world, if someone alleges that you threatened to kill yourself, I’m going to collaborate with the police to lock you up.  Don’t argue with me; I’m the reasonable one. If you try to make a statement about personal liberty, I don’t give a shit”.

    This is pretty much the diametric opposite of addressing undecided middle-of-the-road voters about an out-there issue of personal liberty – this is standing up for personal liberty against someone who has proudly announced their history of and ongoing intention to lock up people who have broken no law.

    > It isn’t a “line of work” for me. It’s who I am. Don’t want me interfering in your decision to off yourself? Fine. Don’t. Get. Me. Involved.

    So your own self actualization is more important than someone else’s liberty.

    How is this argument not exactly the same one that a member of the religious police in Saudi Arabia would make?

    “Worshipping Allah through my work is the most important thing in my life. Don’t want me to beat you with a stick? Fine. Just don’t speak your theological doubts out loud.”

    Why, exactly, is your self actualization more important than my liberty?

    If I wake up tomorrow and have a conversion experience and decide that “arresting” you and locking you in a bunker until you worship a Lego block as God is the most important thing in my life, the very reason I was put on Earth, how is that illegitimate by your standards?

    If your answer is “well, the law supports EMTs arresting people and handing them over to quacks who inject them with mind altering drugs, but it does NOT support TJIC arresting people and forcing them to worship lego blocks”, then I question your devotion to the political class that created those laws.

    > It’s that simple. My number is 911. Don’t call it, or don’t make spiteful threats that spur other people to call it. 

    Just to be clear, you’re saying that my first amendment right to be dramatic and say “If I have to eat one more bite of this leftover soup I’d be better off dead” is null and void because (a) you’ve got a Calling, (b) a friend of mine without a sense of humor calls 911.

    Seriously, how do you justify that to yourself?

    Or, rather, I can understand how you justify that – your self actualization and paycheck require it.

    What I don’t understand is how you simultaneously hold that view AND think of yourself as a pro-liberty person.

    @openid-140901:disqus 

    >  Lets step back and state terms: AD was talking about those situations in which a person has invoked Leviathan: called the ambulance or the cops; called 9-1-1.  And they are threatening to do themselves in.

    We’re talking about a situation in which person Y calls 911 alleging that person X said something and further alleging that person X is serious.

    >  you either called the State/Its Agents or you behaved so incautiously as to get someone else to call.  Why you do that? 

    Look, I don’t shoot heroine, ride a motorcycle without a helmet, or have lots of unprotected sex in a gay bath house, but I stand up for the rights of other people to do things that are stupid and self destructive.

    Why do you not?

    Are you only interested in preserving rights that you yourself exercise?

    >      I’m calling you out. 

    I see that.

    >  I’ve been there, a heartbroken grown-up, observing that when the light is right, you can see your ticket out sitting in the chamber and it’s only going to take a little more pressure-    I chickened out.

    Well, I’m glad you’re still with us.

    …but why should my right to be dramatic suffer because you’ve loaded a pistol and pointed it at your head?

    Are you embracing the left-wing stance that personal freedoms should be limited so as to coddle the least mature and forward thinking among us?

    Should we disarm you, take away your motorcycle, revoke your right to drink, etc., etc., etc. because SOME people have problems with exercising these rights?

    >  We don’t live in Libertopia.  We live *here,* with the State a monster dozing underfoot.

    Dozing?  Why should it awaken itself?  It’s got BATF agents running around, “just doing their job”.  It’s got IRS agents “just doing their jobs”.  It’s got EMTs “just doing their jobs” and arresting people without warrants and jailing them in psychiatric facilities.

    The state has more than enough willing collaborators.

    Not only CAN it happen here, it IS happening here, and if the advice is “well, don’t complain about the dog catcher, he’s an agent of the state, but I’ve met him, he’s a good guy, he’s MOSTLY ok on the whole liberty thing…and don’t complain about the EMT, he’s a good guy too, and he’ll only arrest you wo a warrant if his paycheck depends on it”, then I don’t understand what you think the moral line about what one can legitimately disagree with the State is.

    @710bc434ccbe74ea21e315e3d31ab834:disqus :

    >TJIC and the others seem to be anarchist-lite.  

    I find that insulting.

    …the “lite” part, that is.  ;-)

    > They don’t want to set the world ablaze, but if it catches fire HOW DARE YOU DO ANYTHING ABOUT IT!!!11!!

    Were we talking about someone trying to solve a world on fire? 

    I thought we were merely talking about an EMT who was claiming to (a) be pro-liberty, and (b) claiming that it is his calling in life to lock people up without warrants if they violate an unconstitutional speech code .

    @google-add29a7ecd3cf44fb54712fc07a81167:disqus 

    > A man has cut his wrists with a knife in an apparently unsuccessful attempt to take his own life, but refuses to go to the hospital. Are you seriously proposing that I leave you there? 

    Yes.

    > Then what happens when I do so, and you are killed?

    So are you saying that this is a MORAL question, or a liability question?

    Is your argument “OK, he’s got a RIGHT to kill himself, but I don’t want the paperwork hassle, so I’ll infringe on his rights?”

    I don’t find that to be a moral stance I can respect.

    Collapse>?
    @google-37ac8f2d94998bf6502973f7d5d2021b:disqus > I approach this from the LE side and I agree wholeheartedly with AD. If you say the magic word, you win a free trip.I’ve never met Mike and he may very well be one of the small subset of cops that don’t flout the laws, allow fellow cops to break laws with impunity, give “professional courtesy” passes to friends and families of other cops, lie under oath, fabricate evidence, and arrest people for contempt of cop.  But all cops, even the good ones, enforce all manner of illegitimate laws and live off of stolen tax dollars, so I don’t particularly think “Hey, EMT, like you I (a) take the king’s dollar, and (b) use force to uphold the will of the legislature” to be a particularly convincing argument.

    • Rogue Medic

      tjic,

      A person who threatens to kill himself/herself is not legally considered to have the capacity to make informed decisions about his/her best interests.

      • http://twitter.com/tjic tjic

        > A person who threatens to kill himself/herself is not legally considered to have the capacity to make informed decisions about his/her best interests.

        1) Ambulance Driver isn’t just talking about people who’ve threatened to kill themselves; he’s also talking about people who are ALLEGED to have threatened.

        2) People with 1/4 Jewish blood aren’t considered humans…at least in some jurisdictions and some time periods.

        If “but the law SAYS” or “I’m just following ORDERS” are your moral touchstones and give you the peace of mind to sleep at night with your behavior, fine.  Only you have to deal with your own behavior on behalf of the government and the paycheck it signs.

        • Ambulance_Driver

          And you conveniently ignored the whole thread about “credible threats.”
          I already stated that if someone heard the threat and is willing to sign a police affidavit attesting to it, or if I had a 911 tape of the patient making the threat, that I treat it as credible, and anonymous callers, I generally don’t.
          And I still haven’t heard an apology for the whole Nazi death camp reference.
          That demonstrates quite clearly to me that you, sir, have zero sense of proportion.
          Or for that matter, manners.

          Kelly Grayson

        • Rogue Medic

          tjic,

          Unless it is on video, with sworn witnesses (who satisfy your “moral” standards), nothing happened?

          We should only take threats seriously after we have “proof?”

          The concept of prevention appears to elude you.

        • mpatk

           I’m trying to decide if you have no basic reading comprehension, or you’re just being a deliberate asshole.

          As Ambulance Driver has said, there is SOME discretion involved.  We don’t automatically take the “shady 911 caller”‘s word over the person who is alleged to have threatened suicide.  Claiming that EMTs are just mindless followers who blindly seize people on the orders of the police is both ridiculous and insulting as hell to those of us who put ourselves at risk to help others.

          However, if a patient admits that they threatened to kill themselves, or has made a clear attempt (empty pill bottle + drowsy/disoriented), then we have no choice but to bring them in; both legally and IMHO morally and ethically.

          This is where libertarianism gets into gray areas.  People like you can demand that it become black and white; but reality doesn’t give a damn about your ideological purity.  Take the case of the schizophrenic who can’t afford his medication, and now tries to kill himself because the “voices” (hallucinations) tell him to.  Are you going to walk away and let him kill himself even KNOWING that the impulse is not rational and a result of neurochemical imbalance?  How can you claim that he has the right to kill himself when he clearly is not in control of has faculties?

          …and that’s where it gets into the grey area.  It’s generally acknowledged that, absent a painful terminal illness or excrutiating pain that can’t be relieved, wanting to terminate your own life is not normally a rational decision.  Since we know NOTHING about the people we respond to, should we decide to let them kill themselves on the off chance that they’re the very small minority who are thinking rationally?  Or should we act based on normal behavior, and take them to an expert at the ED who can assess them better?

    • CE

      tjic,
      Will you pay for my mortgage when I lose my job because I took your libertarian advice?

  • http://www.atomicnerds.com/ LabRat

    I do wonder how many of the absolutists have ever themselves experienced a thoroughly altered/mentally incompetent state, or had contact with someone who was actively experiencing one.  (That wasn’t brought on by various illicit substances.) It can be very difficult to grasp the nature of madness as something beyond an abstract concept invented by oppressive authorities until you’ve met it.

  • Urso

    I’m continually amazed at some people’s claims of rationality while I watch them forcibly reject reality as it is, demanding that it be something else,  like cream cheese, perhaps.

    protip for all you libertarians out there – confirming people’s biases that you’re a bunch of asshole nutjobs by acting like a bunch of asshole nutjobs is not going to win you any political or social traction. Jumping up and down on AD’s metaphorical coffee table screaming “SHALL NOT BE INFRINGED” just makes you look like a jerk. Given that I’ve got the social skills of a drunken badger with a sore tooth, and -I- can grasp this, I’m sure you can too.

    love and kisses,

    Urso

  • Mike S

    “First of all, I don’t get to decide.”
    http://en.wikipedia.org/wiki/Nuremberg_defence

    Basically, I see your argument as, “When I show up, you will submit or die, because this is what the state has told us to do.”

    So the big question is: If you weren’t a paramedic and your friends weren’t cops, would you still feel morally justified showing up where where a person has threatened to kill himself, trying to kidnap him, and no matter what he does or says when he realizes you and your armed friends are going to tie him to a cart, lock him in the back of a windowless van and take him your dungeon, you increase force to the point of ventilating him thoroughly with .40 caliber holes?

    If it’s wrong for a normal person to do, it’s wrong for a government employee to do.  Citizens cannot delegate authority they do not have, not even by passing a law declaring it to be so.

    It’s easily illustrated with welfare laws: if it’s wrong for Person A to take money from Person B against Person B’s will (stealing), it is still wrong when a law is passed mandating that Person A go take money from Person B and to give to Person C.

    But hey, at least if you work for the TSA you can fondle little girls and look at pretty women naked and it’s OK — they don’t get to decide either, right?  Nobody gets to decide to disobey the government, because a team of order-followers will show up and force you to submit or kill you while trying.

  • Ambulance_Driver

    If I weren’t a paramedic and my buddies weren’t cops, we wouldn’t be involved.

    And the Nuremberg defense is a damned poor simile.

  • mpatk

     Yay, another troll.

    Mike,

    Have you read the comments where we don’t just accept hearsay from an anonymous source as evidence to take someone in for evaluation?  Our hands are tied if someone makes the self-destructive statement to us and/or the police.

    Are you unaware that society as a whole, and the government in particular, views wanting to kill yourself (in the absence of terminal illness) to be evidence that you are not mentally capable of making decisions on your own welfare?  Because if you are, you’ve been living under a rock; even teenagers are aware that threatening to kill yourself to police or medical people = a psychiatric evaluation.

    As far as my personal opinion goes: if someone wants to kill themselves and has made a calm, rational decision to do so, then that’s their decision.  However, if someone is so stupid, or so much of an attention whore, that they state to police and/or EMS that they want to kill themselves, they’re not worth risking my career over.  They’re bringing Leviathan down on themselves by making such a statement.  I’ll do what I can to help people who have gotten stuck in the system; but not people who deliberately bring the system down on themselves.

    Oh, one request for Mike S.  If you’re going to say bullshit like “windowless van”, “dungeon”, “.40 caliber holes” and “fondle little girls”?  Please go away and let the adults discuss things here; I’m sure there are plenty of other places where your immaturity would be more welcome.

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