Can the Committed Patient Refuse Chemotherapy?

• Problems with involuntarily hospitalized patients refusing to take psychopharmacological medications has taken on several new dimensions in recent years. It is no longer possible to assume that granting of a commitment is tantamount to free license to use standardized and accepted preparations. Many legal concepts and social policy questions have been introduced. Competency to consent or to refuse treatment, or incompetency to consent or to refuse treatment, the nature of informed consent, intrusiveness of the type of treatment, and inquiries into assessment and role of dangerousness connected with mental illness are recurring themes. If we start with mental illness as a preliminary but insufficient condition in itself for involuntary hospitalization, we are left with residual problems of determining which patients, and under what conditions, will receive chemotherapy. A proposal is made that the competent patient, not admitted with dangerousness as an integral part of his mental illness, would have the presumption of choice with respect to the medications he receives. However, if a judicial determination of incompetency with respect to a refusal or consent state was established, treatment with medications could proceed. For those patients in the different category of a joint finding of dangerousness and mental illness, medications could be given without a separate finding of incompetency being made by virtue of their hospitalization under the police power of the state.