The Right to Refuse Treatment 171mentally ill and its consequent effect on the individual's personal liberty ultimately
remain in the hands of the clinician or forensic expert. While the intention of the
doctrine was to consider individual interests in the name of unwanted intrusions on
personal liberty, the practice of mental health treatment essentially disregards this
perspective and reinforces the power that the medical community holds over those
judged to be mentally ill.
Similarly, questions of competency are often raised only when acceptance or re-
fusal of treatment differs from the opinion of the medical community. Decisions that
are consistent with the psychiatrist, for example, are rarely questioned. In the case
of Alyssa, the psychiatrist recommended Thorazine to treat her thought disorder.
Had Alyssa concurred with the psychiatrist's recommendation, there would have
been no issue regarding competency. Psychiatrists often accept a patients consent
without further considering if it is consistent with the physicians opinion. When
a patient challenges the treatment recommendation, however, questions of compe-
tency are likely to be raised. Often, it is thought that the individual lacks insight
into his or her own condition and, thus, is not capable of making rational treatment
decisions. In this instance, the individual may be subjected to a competency hear-
ing to determine his or her capacity to make such a decision (Levy & Rubenstein,
1996). Thus, the right to refuse treatment is often not a right at all, but rather a
right to object and be subjected to a hearing.
Further, while considerable literature and public attention surround the "an-
titherapeutic" aspect of the right to refuse treatment, the "therapeutic" aspect must
also be considered. Examples of the beneficial nature of the right to refuse treatment
include judicial or administrative hearings (following the citizen's refusal of recom-
mended treatment) to ensure that the mentally ill individual has the opportunity
to fully present his or her case in a formal legal setting; the consequent procedures
that help to prevent the inappropriate use of medications (e.g., for punishment or
convenience); and the hearings that ensure that psychiatrists are not prescribing the
wrong medication, wrong dosages, or ignoring concerns of the patient regarding
side-effects (Perlin et ai, 1995). Thus, in addition to the negative or "antitherapeu-
tic" aspects of the right to refuse treatment, forensic psychology must also consider
the beneficial or therapeutic aspects of such a right.
Suggestions for Future Research
Some research has been conducted exploring treatment outcomes of refusers and
differences between clinical and judicial reviews of petitions for involuntary med-
ication (Perlin et al., 1995). Overall, however, there is a lack of quality research
concerning the various "therapeutic" and "antitherapeutic" effects of the right to
refuse treatment (Arrigo & Tasca, 1999). Thus, research on quality of life, impacted
after a decision to accept or refuse treatment, may be beneficial. As noted above,