An empirical view of patients exercising their right to refuse treatment

Abstract

In recent years heated debate in the law-mental health arena has centered on the right to refuse treatment. Similar to previous important interactions in the field, this one caught many in psychiatry by surprise. Using a theoretical model based on mourning (Kubler-Ross, 1969), after denying for years that a patient’s right to refuse treatment was even an issue for consideration, many psychiatrists were shocked and outraged that this also was to be the subject of scrutiny. Legal “bargaining” in the courts confirmed that patients did indeed have the right to refuse treatment. There was despair and fear of destruction of our institutions and a heralded return to Bedlam. We have now moved into a period of acceptance, adjustment, and accommodation. Attention has focused on the specifics of how this right can be assured without causing undue harm to our patients or creating havoc in our psychiatric institutions. In this paper we briefly review the right to refuse treatment from a national perspective. We then describe Oregon’s new informed consent rule which is the administrative procedure for managing involuntary patients refusing treatment. We describe the characteristics and refusal patterns of 82 state hospital patients whose refusal of treatment in 1983 was managed with this new procedure. We conclude with a discussion of our results, highlighting major issues brought to the fore by the Oregon procedure.