Mental Illness and the Freedom to Refuse Treatment: Privilege or Right? - Article Analysis Essay

Introduction

In his article titled "Mental Illness and the Freedom to Refuse Treatment: Privilege or Right?" Ronald Bassman analyzes the issue of forced medications for psychiatric patients and defendants in the context of the decision of the U.S. Supreme Court in Sell v. United States (2003). In this case, the court held that the government, under certain stringent conditions and circumstances, can involuntarily administer antipsychotic drugs to a criminal defendant who is mentally ill in order to render them competent to stand trial. In the article, Bassman (2005) advances various ideas, points, and arguments worth consideration before delving into a personal reaction or opinion of work. At the outset, the author blasts the Sell decision arguing that even though "Sell won his right to refuse to take psychoactive drugs, [but] his victory was a hollow one at substantial cost" (p. 488). He was incarcerated for longer than necessary. This argument finds support in the work of Glasgow (2005) in which it is also argued that even though the criminal defendants' civil rights were strengthened by the Sell decision, unintended consequences were created since it would see mentally ill defendants being incarcerated for longer periods than would be the case if they had been tried and convicted.

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Writing from the lens of a licensed and educated psychologist who has previously been diagnosed with a mental condition and compelled to undergo treatment, Bassman (2005) argues against forcing people to take psychoactive drugs on the various grounds. First, he argues that unless a mentally ill individual exposes other people to some illness or is violent, their constitutional right and freedom of choice to refuse treatment should take precedence. Further, he notes that the holding in Sell is problematic since the court based its reasoning purely on a false premise of efficacy and safety of psychoactive drugs. His other contention is that while most other people are permitted to make foolish health decisions such as smoking without the government intervening, there is an automatic bias against mentally ill individuals who the state considers as not able to make sound decisions in life. Hence, Bassman (2005) contends that mentally ill individuals are unfairly denied the freedom of making poor choices which according to him should be a privilege. Another point that the author makes in his article is that the reason people with mental illnesses resist taking psychoactive drugs is that some of the stances have debilitating side effects on them, such as psychoses, cognitive deficits, lethargy, obesity, diabetes, depression, liver and kidney disease, and blood disorders. Hence, Bassman concludes that philosophically, morally, and ethically, people should be allowed to choose whether or not to undergo drug treatment.

My reaction to or opinion of Bassman's (2005) work is that it represents a well-researched and argued piece containing valid arguments against the involuntary administration of psychoactive drugs on the mentally ill and advocating for the freedom to refuse treatment as being both a privilege and a right. Even though the author has not comprehensively explored the other side of the debate concerning whether people with mental health problems should consent to medical treatments, I agree with him that this issue should be looked at from a logical, philosophical, moral, and ethical angle rather than only through the legal lens. This argument is consistent with that of Rushforth (2014) who argues that it is an unethical practice to treat non-violent psychiatric patients against their will or force them to take medication, hence it should be discontinued. In my opinion, unless the exigent circumstances outlined by the court in Sell apply, mentally ill individuals should be granted the right to choose whether or not to undergo drug treatment and should never be forced into doing so.

As Neilson and Chaimowitz (2015) correctly point out, the right to be actively involved in their health care and to be informed is one that all patients have since the right to make decisions concerning their psychiatric treatment and decline those they do not want is fundamental to their autonomy and dignity. According to these authors, it is important for legal and medical practitioners to understand the ethical underpinning of informed consent which is the principle of self-determination or respect for personal autonomy. Involuntary psychoactive drug administration flies in the face of this important ethical foundation. However, as Bennion (2013) argues, in considering whether or not to authorize involuntary drug treatment for the mentally ill, it is important to consider the effects of a full-blown psychiatric condition on a patient. According to this author, while it is true that some psychoactive drugs can have dangerous and undesirable side effects particularly due to the trial-and-error involved in determining the best treatment drug, it is necessary to weigh the patient welfare interests. Bennion (2013) also argues that research evidence indicates that early drug treatment of mental illness is effective in alleviating the conditions of psychiatric patients and hence it is sometimes justified to involuntarily administer psychoactive drugs.

One of the findings of the court in Sell v. U.S. was that everyone has a significant liberty interest which is constitutionally protected and it includes the right to refuse the unwanted administration of antipsychotic drugs. However, the court also found that for those mentally ill individuals who are so substantially disabled that they are a danger to themselves or to others, the govrnmnt has an overriding interest in involuntarily administering drug treatment to achieve a particular purpose such as rendering them competent to stand trial. The court emphasized that this state interest has to be important and legitimate. Further, as one exception to the general rule on individual liberty to avoid forced treatments, the court found that drugs may be forcefully administered on a psychiatric patient or inmate if it is proved that the treatment is in their best interest medically and health-wise. Of particular significance is the dangerousness exception established by the Supreme Court in Sell under which it must be proved that failure to medicate will result in a substantial risk of physical harm to property, others, or self.

Conclusion

In conclusion, my opinion based on the decision in Sell is that those diagnosed with a mental illness should not be forced to take medications particularly when they are nonviolent offenders or patients. The reason for this is that involuntary drug treatments can sometimes have unintended consequences and effects on individuals as Glasgow (2005) and Bassman (2005) point out. Therefore, as the court observed in Sell, it is necessary for less invasive alternatives to be explored before drugs can be involuntarily administered on a patient and the administration should only be done in rare cases where it is proved that the drugs are safe and are in the inmate's best interest. Further, as Neilson and Chaimowitz (2015) succinctly argue, it is my view too that forced medications on inmates or patients are unethical as they go against the fundamental ethical principles of informed consent, self-determination, and respect for personal autonomy. Legally, such forceful medications also violate the rights of persons with disability as enshrined under the UN Convention on the Rights of Persons with Disabilities. Unless it can be shown using clear and convincing evidence that an inmate is a danger to themselves or to others or that the failure to medicate will lead to deterioration in their mental condition, no individual should be subjected to coerced or compelled psychoactive drug treatment.

References

Bennion, E. (2013). A right to remain psychotic? A new standard for involuntary treatment inlight of current science. Loyola of Los Angeles Law Review, 47, 251-317

Bassman, R. (2005). Mental illness and the freedom to refuse treatment: Privilege or right?Professional Psychology: Research and Practice, 36(5), 488-497

Glasgow, R. (2005). Forced medication of criminal defendants and the unintended consequences of Sell v. United States. Journal of Contemporary Health Law & Policy, 21(2), 235-258

Neilson, G., & Chaimowitz, G. (2015). Informed consent to treatment in psychiatry. Canadian Journal of Psychiatry, 60 (4), 1-11

Rushforth, J. (2014). Ethics and the use of coercion in the treatment of psychiatric patients. Themis: Research Journal of Justice Studies and Forensic Science, 2(6) 98-112