91172.pdf

The Right to Refuse Treatment 169

Literature Review

The right to refuse treatment is considered the "most controversial issue in forensic

psychiatry today" (Perlin et al., 1995, p. 111). To fully understand its impact, one

must consider the issue in light of a number of other important legal concerns;

namely, the Least Restrictive Alternative (LRA) doctrine, competency issues, and

the doctrine of informed consent. We briefly discuss each of these matters as they

relate to the right to refuse treatment.

Least Restrictive Alternative Doctrine and Right to Refuse Treatment

For individuals in need of psychiatric attention, the right to refuse treatment be-

comes relevant within the context of the LRA doctrine. The LRA doctrine holds

that individuals be placed in the least restrictive setting when their condition neces-

sitates state intervention. This doctrine also implies that the least restrictive method

of treatment be employed. Thus, the goal is to treat the individual in a manner that

is least intrusive upon his or her personal liberty.

Without question, the administration of any treatment could be regarded as an

intrusion on personal liberty if the citizen did not wish to receive the treatment. For

example, the administration of psychotropic medication(s) to alleviate symptoms

may be regarded as necessary, but may also significantly effect the individual's mental

functioning. In this instance, one may not wish to be subjected to certain primary

effects and side effects of medication. Thus, if a less restrictive alternative is available,

it must be considered.

Doctrine of Informed Consent

The doctrine of informed consent requires that persons be supplied adequate in-
formation concerning treatment prior to consenting. Thus, the individual is able
to make a well-informed decision regarding the suggested treatment they may be
receiving. Generally, adequate information consists of the risks and benefits of treat-
ment, the potential side effects, the chance of improvement both with and without
the treatment, and any other treatments that may be available. The doctrine applies
in a number of situations, including administration of medication, tests, and surgical
procedures (Levy & Rubenstein, 1996).
While the doctrine of informed consent applies to the general adult public, it
also applies to the mentally ill to the extent that they are competent to make such
decisions. Thus, the existence of a mental disability alone does not take the right
to make treatment decisions away from an individual. In order for such a right to
be lost, the individual must be found incompetent by a court of law. While this
seems simple enough, some controversial issues arise concerning the incompetent
or civilly committed mentally ill and their right to refuse treatment.