The Presumption for Treatment: Has it been Justified?

See, e.g., Ramsey P. , The Saikewicz Precedent: What's Good for an Incompetent Patient, Hastings Center Report 8(6): 8, 39 (December 1979).

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment (U.S. Gov't Printing Ofc., Washington, D.C.) (1982) at 134–35.

Rogers v. Okin, 634 F.2d 650, 653 (1st Cir. 1980), vacated and remanded, sub nom. Mills v. Rogers, 457 U.S. 291 (1982); Rennie v. Klein, 653 F.2d 836 (3d Cir. 1981), vacated and remanded, 458 U.S. 1119 (1982). See Mills M. Gutheil T. , Legal Approaches to Treating the Treatment-Refusing Patient, in Refusing Treatment in Mental Health Institutions—Values in Conflict ( Doudera A. & Swazey J. , eds.) (AUPHA Press, Ann Arbor, Mich.) (1982) at 103 (treatment refusal should be honored unless there is significant evidence that the patient is not competent).

Carter Sestak R.M. Roth L.H. , Informed Consent: A Study of Decision-Making in Psychiatry (Guilford Press, New York, Psychiatry (Guilford Press, New York, N.Y.) (1984) at 35.

See Michels , Right to Refuse Treatment: Ethical Issues, Hospital and Community Psychiatry 32: 251, 252 (1981) (noting that although logically the same level of competency should be required for consenting as for refusing, in practice competency is much more likely to be questioned when the patient's decision is an unpopular one).

See generally Roth L.H. Meisel A. Lidz C.W. , Tests of Competency to Consent to Treatment, American Journal of Psychiatry 134(3): 134 (March 1977).

See Michels R. , Competence to Refuse Treatment, in Refusing Treatment in Mental Health Institutions—Values in Conflict, supra note 3, at 115, 117–18.

Annas G. Glantz L. Katz B. , Informed Consent to Human Experimentation: The Subject's Dilemma (Ballinger Publishing Co., Cambridge, Mass.) (1977) at 152.

Appelbaum P.S. Gutheil T.G. , Drug Refusal: A Study of Psychiatric In-Patients, American Journal of Psychiatry 137(3): 137, 342 (March 1980) [hereinafter referred to as Drug Refusal].

Id. at 342–43 (emphasis added).

Id. at 345.

Id.

Hassenfeld I. Grumet B. , A Study of the Right to Refuse Treatment, Bulletin of the American Academy of Psychiatry and the Law 12(1): 12 (1984) (hereinafter referred to as Hassenfeld & Grumet].

The refuser group had a much longer average hospital stay. Id. at 70. Appelbaum and Gutheil in their study state: “Only for the symptomatic refuser [their term for ones who refused consistently] hellip; did the act of refusal result in serious clinical consequences.” Drug Refusal, supra note 9, at 345.

One died, one was never discharged, and one made a marginal adjustment outside the hospital with frequent visits to the emergency service. Hassenfeld & Grumet, supra note 13, at 72.

Id. at 71–72.

Id. at 72.

Drug Refusal, supra note 9, at 344.

Hassenfeld & Grumet, supra note 13, at 73.

See Rhoden N.K. , The Right to Refuse Psychotropic Drugs, Harvard Civil Rights—Civil Liberties Law Review 15(2): 363, 388–96 (Fall 1980) (discussing M.H. Shapiro's theory that involuntary treatment violates the first amendment by infringing upon freedom of thought).

Drug Refusal, supra note 9, at 345

Michels, supra note 5, at 253.