"Rotting with their rights on": constitutional theory and clinical reality in drug refusal by psychiatric patients.

Abstract

The recently formulated right of hospitalized psychiatric to refuse medication l has drawn increasing attention in the medical and legal literature and in the courts. Unfortunately, almost all that has been written approaches the subject theoretically, from the viewpoint of the development of constitutional law, without paying sufficient attention to the clinical realities or to the actual situation of the patient. The states themselves vary in their attention to the subject. As of November 1977, most states had not addressed the question of medication refusal. Several states defined a right to be free from unnecessary, excessive or punitive medications and/or specified that all medications administered must be medically indicated. Alaska requires the consent of voluntary patients; Connecticut and Louisiana specifically do not require consent of voluntary or involuntary patients, while Oregon notes that all treatment is the sole responsibility of the physician. Four states grant a modified right to refuse: Iowa subject to override by next-of-kin or guardian, Michigan before preliminary court hearing, North Dakota after discharge is requested, and Wisconsin prior to final commitment. 2 Empirically derived data, here as elsewhere, can provide the opportunity for the testing of theoretical constructs. In this paper, after reviewing common misconceptions about medication, we will apply the data derived from a small pilot study3 of who refuse medication to the constitutional arguments for patients' to refuse, in an attempt to determine if the abstract legal concept of patients exercising their rights can be more fully and realistically understood by investigation of the actual circumstances of refusal. Common Misconceptions about Medication as Treatmentt Our experience in working with lawyers and with officers of the court and