AHMF: Conf 2001: SR Molesworth

Legal Issues—Determining the Appropriate Treatment

Simon R. Molesworth AM, QC BA, LLB, FEIA, FAICD, FAIM, FVPELA, Hon.FRAPI Queen's Counsel,

Victoria, Australia
National Chairman,
ME/Chronic Fatigue Syndrome Association of Australia;
President,
ME/Chronic Fatigue Syndrome Society of Victoria;
Board Member, Alison Hunter Memorial Foundation;
National President, Environment Institute of Australia.
19 Linacre Road
Hamptom,
VIC 3188
Australia
mole@midnite.net.au
Ph 613 9225 8571
FAX 613 9225 8570

Across the world the degree to which ME/CFS patients report unsatisfactory treatment is disturbing. Putting aside the challenges of diagnosis and determining appropriate treatment in circumstances where cause and cure are still to be agreed upon within the medical profession, the degree to which medical uncertainties can excuse treatment that proves insufficient, aggravating or harmful raises serious social, ethical and legal issues.

The context provided by medical research, and increasingly numerous surveys of ME/CFS patients, should set the course for a cautionary approach to treatment. The worldwide emergence of significantly credible medical research pointing to biophysical, in particular neurological, explanations for ME/CFS should be shifting the focus of treatment away from psychiatry. Accepting the reality of the biophysical manifestations of the illness appears to be a fundamental safeguard to charting a patient's case history and thereafter determining treatment options.

It is essential that treating medical practitioners be informed by the patient's whole circumstances; their experience and the personal account of both themselves and those within their support circle is critical in pointing the way ahead. Overcoming the "crisis of credibility" by accepting the reality of their illness is essential. Acting on the basis of such information is an essential first step. Thereafter monitoring and being alert to the evident stages of the illness, all go towards informed decision-making and the sharing of responsibilities and, inevitably, liabilities. In reality, the best outcomes are achieved through a form of partnership: a "sharing" of the path to recovery between patient and medical practitioner.