medical
Irrational fear of needles
<p>I want to get an injection (vaccination or treatment) for very good medical reasons. Unfortunately I have an irrational fear of needles (I don’t actually, it’s hypothetical). I can approach a doctor and say I want this injection, I can pay for it if needed, but as soon as a nurse arrives with a needle, I run away, and I definitely don’t consent to the injection at that point.</p>
<p>What can my doctor do legally? Can he ask me to sign a form for example where I consent to the injection <em>and allow him to give me the injection even if I strongly refuse</em> a minute later? If I sign to give him permission to get two strong men to hold me in a chair to give me the injection, against my strong objections at that time, would that be legal?</p>

<h2>Medical PoAs in General</h2>
<p>A medical power of attorney (PoA) is only valid (at least in most US states, the rules vary a bit) when the principal (the person granting the power), is unconscious, unable to make a choice, or legally incompetent.  A fear, even an irrational fear, will not suffice to make a person incompetent.</p>
<h2>Maryland</h2>
<p>To deal with a specific example, consider the law of <a href="/questions/tagged/maryland" class="post-tag" title="show questions tagged &#39;maryland&#39;" rel="tag">maryland</a>.</p>
<p>According to the article on &quot;Powers of Attorney&quot; from <em>The People's Law Library</em> :</p>
<blockquote>
<p>Unless otherwise stated in the advance directive, the directive goes into effect when the person becomes too sick to make a decision about his care. If the patient is unconscious or not able to communicate, then the attending doctor may make the determination that the advance directive is in effect. Otherwise two doctors must certify that the patient is not capable of making an informed decision about care.</p>
</blockquote>
<p>More specifically to use a Maryland advance directive (healthcare PoA) for the purpose described in the question, a person would need to create a written Advance directive under code §5–602(a). It would need to include language waiving the right to revoke the directive. The person would then need to be formally declared &quot;incapable of making an informed decision&quot; about injections by two physicians. Then, and only then, would anyone acting under the PoA be justified in restraining the principal and forcibly administering an injection.</p>
<p>I suspect one would find many health care facilities very apprehensive of malpractice suits and other possible legal complications in such a situation, and thus very reluctant to undertake care in such circumstances.</p>
<h4>Specific Maryland Laws</h4>
<p>Maryland code <a href="https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&amp;section=5-602" rel="nofollow noreferrer">section 5–602</a> reads, in relevant part:</p>
<blockquote>
<p>(a) (1) Any competent individual may, at any time, make a written or electronic advance directive regarding the provision of health care to that individual, or the withholding or withdrawal of health care from that individual.</p>
<p>(a) (2) Notwithstanding any other provision of law, in the absence of a validly executed or witnessed advance directive, any authentic expression made by an individual while competent of the individual’s wishes regarding health care for the individual shall be considered.</p>
<p>...</p>
<p>(e) (1) Unless otherwise provided in the document, an advance directive shall become effective when the declarant’s attending physician and a second physician certify in writing that the patient is incapable of making an informed decision.</p>
<p>(e) (2) If a patient is unconscious, or unable to communicate by any means, the certification of a second physician is not required under paragraph (1) of this subsection.</p>
</blockquote>
<p><a href="https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&amp;section=5-601&amp;enactments=False&amp;archived=False" rel="nofollow noreferrer">§5–601</a> reads:</p>
<blockquote>
<p>(f)    “Competent individual” means a person who is at least 18 years of age or who under § 20–102(a) of this article has the same capacity as an adult to consent to medical treatment and who has not been determined to be incapable of making an informed decision.</p>
<p>...</p>
<p>(m) (1) “Incapable of making an informed decision” means the inability of an adult patient to make an informed decision about the provision, withholding, or withdrawal of a specific medical treatment or course of treatment because the patient is unable to understand the nature, extent, or probable consequences of the proposed treatment or course of treatment, is unable to make a rational evaluation of the burdens, risks, and benefits of the treatment or course of treatment, or is unable to communicate a decision.</p>
</blockquote>
<p><a href="https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&amp;section=5-604&amp;enactments=False&amp;archived=False" rel="nofollow noreferrer">§5–604</a> reads:</p>
<blockquote>
<p>(a) (1) Except as provided in paragraph (2) of this subsection, an advance directive may be revoked at any time by a declarant by a signed and dated written or electronic document, by physical cancellation or destruction, by an oral statement to a health care practitioner or by the execution of a subsequent directive.</p>
<p>(a) (2) A declarant, knowingly and voluntarily, may elect in an advance directive to waive the right under paragraph (1) of this subsection to revoke any part or all of the advance directive, including the appointment of an agent, <strong>during a period in which the declarant has been certified incapable of making an informed decision</strong> under § 5–602(e) of this subtitle.</p>
<p>(b)    If a declarant revokes an advance directive by an oral statement to a health care practitioner, the practitioner and a witness to the oral revocation shall document the substance of the oral revocation in the declarant’s medical record.</p>
</blockquote>
<h2>Alternate Procedure</h2>
<p>In many cases it is possible to treat and mitigate irrational fears. The process is not instant, but it is often effective, I understand. The hypothetical patient might be wise to undertake such treatment.</p>
<p>It is possible to render a person unconscious without using an injection, although this has significant risks. That is not a legal issue, but a person could consent to such a procedure, and then be injected while unconscious.  Whether a doctor would be willing to undertake this I cannot say.</p>
<p>Some medications normally taken by injection can be administered by other routes, but I gather that some cannot, so this might or might not be a useful solution.</p>

<p>This of course varies greatly between jurisdictions. But in general, there is such a thing as <em>Power of Attorney</em>. If you, in at a time where you are mentally capable of doing so, appoint someone as your attorney in medical matters, specifically to deal with such known mental health problems, then they can act in those conditions to safeguard your health and wellbeing.</p>
<p>Since you need to be mentally well to both appoint and dismiss this attorney, and you have made it clear up front that this irrational fear is such that you cannot be acting sanely when overcome by that fear, you cannot dismiss the attorney at that particular moment.</p>
<p>Of course, as noted in the comments, the attorney should accept a reasonable doctors proposal to safeguard your mental health during the procedure.</p>
