procedural justice fosters may therefore increase the
effectiveness of the medication that the individual is
required to receive and the likelihood that he or she
will continue to take it even when not forced to do so.Waiver of Right to Refuse Treatment:
The Informed Consent Doctrine
Of course, not all patients will refuse psychotropic
medication. The right to refuse treatment may be
waived as long as the requirements of the informed
consent doctrine are satisfied. These include disclo-
sure of treatment information, competency, and vol-
untary choice. In fact, when the requirements of
informed consent are satisfied, patients may enter into
advance directive instruments that express their
wishes concerning the acceptance or rejection of treat-
ment at a future time when they may become incom-
petent. Although not yet in widespread use for this
purpose, advance directive instruments are likely to
emerge as an important way for dealing with the right-
to-refuse-treatment question in the future.Professional Ethics and
Therapeutic Jurisprudence
Apart from legal restrictions on involuntary medica-
tion, forced treatment raises ethical concerns for clini-
cians. The professional ethics of the various clinical
disciplines strongly favor voluntary treatment. Moreover,
psychological theory would suggest that voluntary
treatment is more efficacious for many patients than
coerced therapy. Coercion may spark patient resis-
tance, whereas voluntary choice may engage the
patient’s intrinsic motivation and increase treatment
compliance. As a result, the principles of beneficence
and nonmaleficence, which are at the core of profes-
sional ethics, would strongly favor voluntary approaches
and the use of less intrusive techniques before involun-
tary medication is attempted. Because psychological
theory would predict that voluntary treatment will be
more effective than coerced treatment and more likely
to produce treatment compliance over time, considera-
tions of therapeutic jurisprudence also would favor
voluntary over involuntary treatment.
Of course, these therapeutic benefits of voluntary
choice may not apply when the individual is incompe-
tent to engage in rational decision making. However,
even for patients rendered incompetent as a result of
their mental illness, once medication has succeeded inrestoring competency to make treatment decisions,
these ethical and therapeutic jurisprudence concerns
can present therapeutic opportunities.
Judges, attorneys, and clinicians called on to act in
the forcible medication context, thus, should under-
stand that they function as therapeutic agents in the
way they treat the individual who seeks to resist
unwanted medication. Judges and clinicians involved
in involuntary treatment therefore should treat patients
fairly, with dignity and respect, and accord them a
sense of participation in the decision-making process.
The hearing that often will be required before involun-
tary medication may be imposed, if structured to sat-
isfy these conditions and properly conducted, can
have a significant therapeutic value. Rather than
resisting the patient’s right to refuse treatment, clini-
cians should understand that recognition of such a
right and the patient’s participation in treatment deci-
sion making can present therapeutic opportunities.Bruce J. WinickSee alsoCivil Commitment; Forensic Assessment; Mental
Health Law; Therapeutic JurisprudenceFurther Readings
Riggins v. Nevada, 504 U.S. 127 (1992).
Sell v. United States,539 U.S. 166 (2003).
Washington v. Harper, 494 U.S. 210 (1990).
Winick, B. J. (1997). The right to refuse mental health
treatment.Washington, DC: American Psychological
Association Books.
Winick, B. J. (2005). Civil commitment: A therapeutic
jurisprudence model.Durham, NC: Carolina Academic
Press.FORENSICASSESSMENT
Forensic assessment is a part of the broader category of
psychological assessment. The purpose of forensic
assessment is distinct from that of traditional therapeu-
tic assessment, and as such forensic evaluators have
different training and practice guidelines. The settings
in which forensic evaluations occur are vast, including
law enforcement, correctional, and civil and criminal
court settings. Forensic assessment may include
traditional psychological assessments and specially
designed forensic measures.328 ———Forensic AssessmentF-Cutler (Encyc)-45463.qxd 11/18/2007 12:42 PM Page 328