168 7 Court and the Legal System—Civil ForensicsRIGHT TO REFUSE TREATMENTIntroduction
The concept of personal liberty is, perhaps, the most treasured of all human rights
in contemporary American society. The longstanding contention that lies at the
historical core of American legal and social thought holds that the individual should
have the right to decide what does or does not happen to his or her body and mind. If
one becomes physically ill, for example, one can often choose not to receive medical
treatment. The same should arguably apply to mental illness. The legal reality is,
however, that this freedom from unwanted intrusion is not always enjoyed by the
mentally disordered citizen. In fact, in some situations, individuals are subjected to
psychological treatment against their will. This is the controversy surrounding the
"right to refuse treatment."
Although questions of treatment refusal are relevant when considering the legal
ramifications of any form of treatment, such questions are generally raised regarding
psychotropic medications. The question of right to refuse antipsychotic medica-
tion lias been called "the most important and volatile aspect of the legal regulation
of mental health practice" (Perlin, Gould, & Dorfman, 1995, p. 111). Issues in-
cluding personal autonomy of the mentally ill to refuse medication, subjection to
drugs which occasionally cause irreversible neurological side effects, and questions
of "informed consent" and "competency," as well as the "least restrictive alter-
native," all potentially become significant when confronting the right to refuse
treatment. This section explores these concerns in the context of the right to refuse
treatment.
Alyssa is a 34-year-old woman who has been diagnosed by her psychiatrist as suffer-
ing from a thought disorder. Her symptoms, including delusions and occasional auditory
hallucinations, have become progressively worse over the past year-and-a-half. While
there is no dispute as to whether Alyssa is mentally ill, she shows no signs of dangerous-
ness to herself or others. Alyssa has been able to maintain a reasonably "safe" lifestyle
and, although she is in a state of obvious mental discomfort, she is not a candidate for
involuntary commitment at this time.
Following her diagnosis, her attending psychiatrist recommends that she be placed
on Thorazine, an antipsychotic drug that may help to alleviate her symptoms. Follow-
ing extensive consideration by Alyssa, she asks that the recommended treatment no! be
implemented. In other words, she asks not to be placed on Thorazine. Alyssa reached
her decision after learning about the drug, finding that it often causes severe side effects
which may be permanent. Alyssa decides that the risk is too high and she wishes to seek
alternative treatment(s).
Upon learning of Alyssa's request, however, her psychiatrist questions her competence
to make such a decision. He questions whether a reasonable person in need of psychiatric
treatment could reach such a decision, as it would clearly not be in her best interest at
this time. In light of her wishes and his concern, does Alyssa have a right to refuse
medication? Does her psychiatrist have a right to involuntarily treat her as he sees fit?
And. how exactly does the issue of competence come into play?