Right to Refuse Treatment Flashcards
principles of involuntary tx
parens patriae
- conflict w/pt’s liberty
- person must be legally incompetent
police powers
- right to protect other from harm
constitutional challenges to involuntary tx
right to privacy
- aka rt to be left alone
- penumbral right, inferred from constitution (1st, 3rd, 4th, 5th, and 9th amendments)
1st amendment
- free speech (rt to generate thoughts and mentation)
- freedom of religion
8th amendment
- protects against cruel & unusual punishment
14th amendment
- protects a pt’s liberty interests against unwanted admin of psychiatric drugs
Rennie v Klein
3rd Circuit Court of Appeals, 1983
Antipsychotic drugs may be administered to an involuntarily committed mentally ill pt whenever, in the exercise of professional judgment, such an action is deemed necessary to prevent the pt from endangering himself/others.
The Court affirmed its earlier decision that the NJ procedures provided in their Administrative Bulletin 78-3 satisfied Due Process requirements. (refusing pt was entitled to review of case by tx team and medical director: TX-DRIVEN MODEL, ie 2nd physician decision-maker)
Rogers v Commissioner
MA Supreme Judicial Court, 1983
A committed pt is competent until judicially found incompetent. A judge, using a full adversarial hearing, then decides, using a substituted judgement model, what the incompetent pt (ward) would have wanted if competent.
No state interest supersedes this rt except an emergency or likely harm to self/others.
Substituted judgment is based on 6 factors:
1. pt’s previously expressed preference
2. pt’s religious convictions
3. impact on family from pt’s viewpoint
4. probable side effects
5. prognosis w/tx
6. prognosis w/o tx
RIGHTS-DRIVEN MODEL (vs Rennie’s tx-driven model)
Matter of guardianship of Roe
MA Supreme Judicial Court, 1981
If an incompetent person refuses antipsychotic drugs, must:
- seek judicial determination of what pt would want to do when competent
- “substituted judgment”
Richard Roe, a bright and popular HS student, developed schizophrenia and became dangerous. Hospital recommended parents go to court, find Richard incompetent, appoint father guardian, and grant father power to decide if Richard should take meds. Judge granted all requests, but guardian ad litem appealed.
Holding: Richard was incompetent and dangerous, needed a guardian, father was appropriate choice, but father could not make tx decisions, and only a JUDGE can make “detached but passionate investigation.”
Utah Model of involuntary tx
Person is found incompetent for decision making as a condition for commitment.
Washington v Harper
USSC 1990
The State may treat a mentally ill prison inmate w/antipsychotic meds if dangerous to self/others and tx is in their medical interest.
The proper standard for determining the validity of a prison regulation claimed to infringe on an inmate’s constitutional rights is to ask whether the regulation is “reasonably related to legitimate penalogical interests.”
Riggins v Nevada
Riggins challenged his murder and robbery convictions on the grounds that the State unconstitutionally forced him to take an antipsychotic during his trial to maintain competence. At his trial, Riggins testified in his insanity defense and was convicted and sentenced to death. Nevada SC held that the expert testimony given was sufficient to inform the jury of the AP’s effect on Riggins’ demeanor and testimony.
Holding: The forced admin of AP med during his trial violated 6A and 14A rights. Invol tx must be least intrusive and most medically appropriate.
Sell v U.S.
USSC 2003
Sell was delusional dentist charged with Medicaid and insurance fraud, and later charged w/attempt murder of FBI agent who arrested him. Found incompetent and refused meds.
Holding: The State may involuntarily administer antipsychotics to a criminal defendant to render him competent IF
- there is an important govt interest at stake
- medication furthers State’s interests
- med is necessary vs less intrusive means
- med is medically appropriate
Hargrave v Vermont
2nd Circuit 2003
Nancy Hargrave was civilly committed. Had a DPOA (durable POA) forbidding her agent from consenting to psychotropics. The hospital medicated her in a non-emergent situation. She sued, claiming her DPOA was ignored bc of her MI and that her MI rendered her disabled and thereby protected by the ADA. Vermont Act 114, which allowed the state to medicate a civilly committed individual even if they had a DPOA refusing tx, had no corresponding mechanism for medication over objection for ppl who were only physically ill. District court granted summary judgment in favor of Ms. Hargrave, stating Vermont Act 114 singled out mentally ill for discrimination and thus violated the ADA. 2nd Circuit Court upheld the holding.
Application of President & Directors of Georgetown College
DC Circuit 1964
Jehovah’s witness refused life-saving blood transfusion.
Imminent danger of death trumped an incompetent pt’s religious objections to emergency medical tx in the District of Columbia.
