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When Treatment Becomes Coercion - A Legal Perspective

NCJ Number
Annals of the New York Academy of Sciences Volume: 347 Dated: (June 20, 1980) Pages: 199-208
A H Einhorn
Date Published
10 pages
This paper explores the emerging 'right' to refuse treatment in light of judicial efforts to adapt that right to the day-to-day realities of institutional psychiatric care.
While many of the early right-to-refuse cases have recognized such a right only in circumstances involving the use of aversive and intrusive treatment modalities--eg., psychosurgery, electroconvulsive therapy, aversive reinforcement conditioning--or in circumstances where modalities otherwise customarily employed had been used for experimentation or punishment, recent court decisions have extended the right to refuse to include customary and accepted forms of treatment. In Rennie v. Klein, a Federal court held that involuntary psychiatric patients possess a qualified right to refuse psychotropic medication. The initial decision typified the impracticality and inappropriateness of traditional judicial mechanisms for everyday treatment decisions regarding the mentally ill. A second ruling, Rennie II, established a mechanism for the enforcement of patients' rights. This order provided for (1) informed written consent; (2) patient advocates; (3) informal review by an independent psychiatrist before an involuntary patient can be forcibly medicated; (4) enforcement of voluntary patients' right to refuse treatment; and (5) forced medication only in emergency circumstances. In an improvement upon the Rennie II mechanism, civil rights officers (CROs), selected from a panel of court-appointed qualified psychiatrists, would review and evaluate treatment decisions either when the patient's ability to render such a decision is alleged to be impaired or when the patient refuses treatment considered essential to his well-being. All decisions of the CRO would be subject to appeal to the local court of general jurisdiction and the CRO would be protected from liability for any injury resulting from a good faith decisions rendered by him. Twenty-one references are appended.