Competency to refuse psychotropic medication: three alternatives to the law's cognitive standard.
Year: 1993
Type: article
Abstract: ALTERNATIVES 691•in the case of mentally ill prisoners), 4 most courts considering the issue on state constitutional, statutory, or common law grounds have found such a right.5 The question then arises: what is it to be competent to refuse psychotropic medication?In an earlier article on this topic, Competency to Refuse Treatment, 6 I argued that the law's treatment competency standard 7 is very attractive, surviving comparison with a number of competing cognitive standards.8 That standard, briefly stated, is that a person is competent to make a treatment decision if she comprehends the caregiver's explanation of her condition and the treatment, and forms no patently false beliefs-"delusions"-about her condition and the treatment.This standard results in some controversial conclusions, such as that a psychiatric patient is competent to refuse medication even though her refusal is based on the belief that she is not ill or the belief that she is bad and deserves to suffer.These beliefs simply are not delusions in the law.Yet the standard that justifies these conclusions seems clearly justified on philosophical grounds.This Article evaluates alternative treatment competency stanexistence of consent in some way.But once there is evidence that the consent is genuine, no further inquiry may be necessary.Of course, competency is not the only issue.Caregivers may deny patients the right to refuse on bases other than incompetency, such as the patient's danger to others.See, e.g., Davis v. Hubbard, 506 F. Supp.915, 937 (N.D. Ohio 1980); In re Orr, 531 N.E.2d 64, 73 (Ill.App.Ct. 1988); Gundy v. Pauley, 619 S.W.2d 730, 731 (Ky.Ct.App.1981); Williams v. Wilzack, 573 A.2d 809, 810 (Md.1990).When I speak of a right of competent patients to refuse, I mean to refer to cases in which the choice is purely self-regarding.4. See Washington v. Harper, 494 U.S. 210 (1990) (prisoner-patients who are mentally ill and dangerous or gravely disabled may be medicated if the medication is in their best interests, even if the protesting patient is competent). 5.For courts that have found a right of competent patients to refuse medication in nonemergencies on state law grounds, see, e.g., Nolen II v. Peterson, 544 So. 2d 863 (Ala.1989); Riese v.St. Mary's Hosp.& Medical Ctr., 271 Cal.Rptr.199 (Cal.Ct.App.1987); Bradshaw v. State, 816 P.2d 986 (Idaho 1991); In re Orr, 531 N.E.2d 64 (Ill.App.Ct. 1988); Rogers v. Comm'r of Mental Health, 458 N.E.2d 308 (Mass.1983); Opinion of the Justices, 465 A.2d 484 (N.H. 1983); Rivers v. Katz, 495 N.E.2d 337 (N.Y. 1986); In re Guardianship of Willis, 599 N.E.2d 745 (Ohio Ct.App.1991); State ex rel.Jones v. Gerhardstein, 416 N.W.2d 883 (Wis.1987).A small number of courts have failed to recognize a right of competent patients to refuse medication on the basis of statutes permitting medication in some non-emergency circumstances.See, e.g., In re Mental Commitment of M.P., 510 N.E.2d 645 (Ind.1987); Williams v. Wilzack, 573 A.2d 809 (Md.1990); State v. Nording, 485 N.W.2d 781 (N.D. 1992).To the extent that litigators continue after Harper to bring right-to-refuse actions on federal constitutional grounds, we must presume that they have judged state law to offer no greater protection than the federal constitution.6. Elyn R. Saks, Competency to Refuse Treatment, 69 N.C.L. REV.945 (1991).7. I use the phrase the "law's treatment competency standard" as arbitrary shorthand for my reading of a set of cases in the United States in the twentieth century.8. Id. at 947-48.
Source: PubMed
Author: E R Saks
Institution: University of Southern California
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W945055537