(1/2 Needles) I have a character (pro-athlete, male, 22, super healthy) who is found stabbed and unconscious; he needs surgery for a small bowel resection. The kicker here is, he's extremely trypanophobic (afraid of needles). The doctor working on him knows of the fear and that he would most likely refuse treatment if he were aware; however, he has not created any sort of medical directive or set any specific instructions because he has panic attacks whenever anybody tries to push him to do so.
(2/2 Needles) What are the ethics of treating him when it’s fairly well known he wouldn’t want it but isn’t able to deny it? Would he be kept sedated through the period of time when he would need to be fed intravenously due to his fear of needles? How would pain management be handled for him if he reacts badly to swallowing pills? Thanks for the help! You are a life saver (both literally and figuratively!) when it comes to character trauma :)
Hey there @mari-lwyd ! Thanks for your ask!
Content Warnings: Needles, spiders.
Frankly, your character’s fear of needles is a distant, tertiary concern once his life is at stake. I, as his fictitious medical provider, couldn’t give a crap what he’s afraid of. I care that he’s dying.
Look, I’m afraid of spiders. I’m not phobic, but they make me really uncomfortable. But if I were stabbed and dying, but you had to put a magical healing spider on my unconscious face to save my life because Reasons™ , it would be desperately unethical of you not to put the spider on my face. Yes, I’m afraid of them. But I also shouldn’t die because of a fear.
So your character is getting whatever care he needs, and fear can be managed later. The doctrine is called implied consent, where the general idea is that if someone is unable to make decisions for themselves, they’re assumed to consent to care that will save their lives.
He’s going to be getting IVs (yes, more than one), probably a breathing tube, and surgery to repair the trauma.
Now, as for IVs. Most people are afraid of needles, not the IV that comes after. It’s not pleasant, but from what I’ve seen it’s not usually triggering. IVs haven’t had needles left in them in quite some time; these days, the lines are just a small plastic tube that’s left behind and the needle itself is withdrawn. So he may be able to tolerate the IVs regardless of his trypanophobia.
What’s going to be a pain in the ass for both him and his poor nurse is the frequency with which they will need to draw bloods after he wakes up. Hospitals tend to draw blood 3-4 times a day in admitted patients, especially ICU patients and post-op patients, to make sure a) he’s getting enough nutrition/electrolytes, and b) that he’s not continuing to bleed internally after his surgery or getting an infection.
As for sedation… it depends on the point to which the character is afraid of needles. He’ll be on pain management after the surgery, which will help keep him calm, but it’s also not the same thing as sedation.
Sometimes we have to face what we fear to get what we need. In this case, his IVs will literally keep him alive. It sucks, it’s no fun, but it’s necessary.
Hope this helps!