Psychiatric Patients Rights to Refuse Treatment Legal Rights of by mburr


									                 Psychiatric Patients’ Rights to Refuse Treatment
        Legal Rights of Voluntary and Involuntary Patients Under Pennsylvania Law

People who are being treated for mental        a much greater degree than the right of
illness, like all other people, generally      “involuntary” patients.
have a right to refuse unwanted medical
treatment. This “right to refuse treatment”    What are the requirements for being
extends, except in limited circumstances,      compelled to enter a treatment program
to the right to refuse treatment with          as an “involuntary” patient?
psychiatric medications. This fact sheet is
designed to give an overview of the            Under Pennsylvania law, an individual
circumstances in which persons who are         must present a clear and present danger to
being treated for mental illness in            self or others in order to be subject to
Pennsylvania have the right to refuse to       involuntary treatment. Depending on the
take psychiatric medications.                  length of treatment, certain procedural
                                               safeguards, including in many cases a
       BASICS OF THE                           judicial proceeding, must accompany this
RIGHT TO REFUSE TREATMENT                      determination of dangerousness.

What is the legal basis for the right to       Except for short-term emergency care, an
refuse treatment?                              involuntary patient must be placed in the
                                               least restrictive treatment environment
In Pennsylvania, Mental Health Bulletin        appropriate to his treatment needs.
99-85-10: “Administration of Psychotropic      Commitment can be on an in-patient or
Medication to Protesting Patients”, sets out   out-patient treatment basis.
the standards to be followed in
determining whether a psychiatric patient      Can a “voluntary” patient be converted to
can be subject to involuntary medication.      “involuntary” status?

VOLUNTARY VS. INVOLUNTARY                      “Voluntary” patients can be converted to
        STATUS                                 “involuntary” status if they seek to
                                               withdraw from treatment, or seek to
What is the difference between a               decline a particular treatment suggested by
“voluntary” and an “involuntary”               treatment personnel. However, the same
patient?                                       showing of dangerousness must be made,
                                               and the same procedures must be followed,
“Voluntary” patients are those people who      as would be required to designate someone
have consented to be treated in a particular   “involuntary” at the outset of their
out-patient or in-patient treatment            treatment.
program. “Involuntary” patients are those
people who are committed against their                SCOPE OF THE RIGHT
wishes. The law protects the right of
“voluntary” patients to refuse treatment to
What rights do voluntary patients have to           independent examination of the
refuse treatment?                                   patient and his/her medical records.
                                                    In determining whether the
Under state law, a voluntary patient can            medication is necessary, the
refuse psychiatric treatment unless he              consulting psychiatrist must
poses an imminent threat of danger to self          consider the value of the
or others. If staff conclude such a threat is       medication in light of the fact that it
present, the patient will be subject to             will be administered over protest,
involuntary commitment. If the person               the reasons for the protest and any
does not meet the involuntary commitment            alternative treatments that are
standards and refuses medication, he may            available that would be less
be subject to transfer or discharge except          objectionable to the patient.
in emergency circumstances.
                                                !   If the second psychiatrist does not
What rights do involuntary patients have            concur as to the necessity of the
to refuse treatment?                                treatment, the treatment team may
                                                    either not proceed with the
An involuntary patient may be subject to            medication, or seek an independent
forced medications in an “emergency”                examination by a third psychiatrist.
which means that it is necessary to protect         If the third psychiatrist also does
the health and safety of the individual and         not concur with the necessity of the
others. Present such an emergency, an               treatment, the treatment may not be
involuntary patient can be forcibly                 administered.
medicated only if all of the following
procedures are satisfied:                       !   If, following the initial round of
                                                    medication, the patient continues to
!      The responsible treatment provider           object to the treatment, the
       must determine and document that             necessity of the medication must be
       the medication is required to                independently reevaluated by a
       provide adequate treatment or to             psychiatrist every 30 days.
       prevent physical injury. In so
       doing, the provider must consider
       the patient’s wishes and the
       existence of any less intrusive

!      Informed consent must be sought
       and the reasons for the medication
       discussed with the patient.

!      If the patient continues to refuse to
       consent to treatment, a second
       psychiatrist must complete an

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