Treatment refusal in psychiatric practice
Historically, individuals with mental illness have had more limited rights to refuse treatment than those without mental illness. is was primarily the case for patients committed to psychiatric facilities, but also applied to some voluntary patients (Appelbaum 1994). Until the last quarter of the twentieth century, society granted psychiatrists the authority to determine the course of treatment for committed patients and, if necessary, to administer the treatment over the patient’s objection. Now, virtually every jurisdiction recognizes that all patients, regardless of their commitment status, have some rights with regard to treatment refusal. In order to understand the current legal approaches to treatment refusal, it is necessary to explore the factors that led to this dramatic change in the nature of doctor-patient relationships in psychiatric institutions. Developments in mental health case law, the evolution of the informed consent doctrine, and public perception about the quality of care delivered in psychiatric institutions all played important roles with respect to the currently recognized right to refuse treatment (Hoge et al. 1989; Perlin 1993; Appelbaum 1994; Winick 1997; Appelbaum and Gutheil 2007).
