Right of active duty military personnel to refuse psychiatric treatment

Under Federal Court precedents, mentally ill patients have a qualified right to refuse treatment. The amount of due process that may be required to override treatment refusals by active duty military patients is discussed. Due process for these individuals need not be judicial, since medical review satisfies federal requirements. Involuntary administration of medication to active duty military personnel is justified in some circumstances. Specific criteria for overriding treatment refusals are suggested. A sample protocol for overriding the treatment refusals of active duty personnel is offered.     

Legal implications for failure to comply with advance directives: an examination of the incompetent individual's right to refuse life-sustaining medical treatment

Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an incompetent individual to refuse life-sustaining medical treatment. The article examines advance directives along with various judicial decision-making standards for incompetent individuals and explores the sociobehavioral and legal rationale for compliance with incompetent individual's rights to make end-of-life decisions. Finally this article concludes (i) that advance directives allow competent individuals to state the medical treatment they would prefer in the event they should later become incompetent and (ii) that when advance directives are properly executed in a detailed manner, under laws currently in effect in some jurisdictions, the preferences stated in the directive bind health care providers.     

Law and antipsychotic medications

This article reviews the origin and development of recent legal concepts surrounding use of antipsychotic medications. Complications (side effects) of certain psychiatric medications are seen as fueling the right to refuse treatment doctrine in the law. The leading cases in right to refuse treatment and right to object to treatment are presented and analyzed. The impact of Supreme Court actions on these concepts is evaluated. The influence of the various legal interpretations of right to refuse treatment on standards of psychiatric practice is explored. Have these laws made a difference on the standard of care in public mental institutions?     

What Right to Die?

This letter first discusses two meanings of a "right to die." In the popular sense, the term refers to a right to refuse life-sustaining treatment. In the strict sense, the term signifies an affirmative right to obtain death--a right to suicide. The letter then explores the legal implications of a suicide right. This right would extend to competent adults, mature minors, and probably also incompetent persons. Counselors would have to inform clients of the suicide option. Intervention to prevent suicide could trigger civil liability. Suicidal intentions would not justify involuntary commitment. Consent would become a defense to homicide.     

论医疗权及其实践

患者的医疗权可以表现为宪法上的应然权利和实践中的实然权利.在具体医疗实践中,患者获得公正、必须和费用节省的医疗服务的权利,是以患者支付医疗费用为前提的.在特定情况下,虽然患者无支付能力,也可以享有医疗权.患者有拒绝医疗的权利.     

Competency to be executed: A therapeutic jurisprudence perspective

This Article analyzes the concept of competency to be executed. It examines the Supreme Court's 1986 decision in Ford v. Wainwright, discussing both its Eighth Amendment and procedural due process determinations. It then considers the standard that should be applied in determining competency in this context and the procedures that the states should utilize to insure a fair determination consistent with due process. The article then considers the perplexing problem of whether an incompetent death row prisoner may assert a constitutional or statutory right to refuse treatment designed to restore him to competency for execution, examining both the constitutional and therapeutic implications of involuntary treatment in this context.     

Autonomy and the refusal of life-prolonging therapy

Conclusion Autonomous decision-making over therapy options is not reducible to the refusal of unwanted medical intervention. This is a myth that has been imported from questionable assumptions in political economy, and is of little benefit to medical practice and the sometimes agonizing decisions which have to be taken by patients and their relatives. An individual's right to therapy abatement can be protected from abuse only in the context of a full understanding of autonomous choice; not merely the right to refuse, but the opportunity to receive assistance and consider alternatives. Limits are also required on the role of the surrogate in the refusal of therapy. Policies endorsing therapy abatement and exercise of the right to forego life-sustaining therapy should carry cast iron guarantees that they will not be disadvantageous to the poor and undereducated members of society. It should also be noted that fears of unlimited life-prolongation have been greatly exaggerated. In an atmosphere of governmental indifference to the plight of the sick, with the notion of welfare tuned to market forces, there is a danger that self-determination can have a restricted meaning; the option of death in the context of an underfunded health service. This may not be the time to campaign for the right to refuse therapy, but rather the time to campaign for improvements to existing therapy.     

Therapeutic jurisprudence and the resolution of value conflicts: what we can realistically expect, in practice, from theory

This article assesses the criticisms of therapeutic jurisprudence that it cannot resolve value conflicts, especially between autonomy rights and therapeutic values, or, less radically, that it has not provided a general method for resolving conflicts. Grounded in general jurisprudential principles about conflict resolution, including novel developments respecting the meaning of weighing and balancing, the article rejects the criticisms as unfounded. The article also develops and critiques arguments maintaining that therapeutic jurisprudence cannot resolve certain value conflicts because the values are incommensurable. The argument is illustrated by examples concerning the right to refuse treatment, and jurisprudential analyses of that right.     

Pacemaker deactivation: withdrawal of support or active ending of life?

In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient??s ??self.?? The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient??s right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life.     

Adolescents' Rights of Access to Counseling

This article focuses on hindrances and problems confronting the adolescent and counselor when adolescents have to surrender their right to accept or to refuse treatment.     

L’évaluation de la perte de chance en responsabilité médicale,une mission à repréciser pour l’Expert

Loss of opportunity, which today is considered as a prejudice in its own right, both for the French Supreme Court and the Council of State, remains undeniably difficult to assess in practice. For many years, the issue of compensation for breach of duty of disclosure gave the various courts the ability to roadtest this concept. However, although the criteria defining this concept, of judicial origin, have been established, the modus operandi allowing the judge to quantify it does not exist. How can this portion of personal injury be determined in relation to the size of the opportunity lost? This is primarily a technical issue, similar to that of assessing a disability rate. However, this request does not feature in typical common law missions for judicial or administrative medical expertise. The judge alone is left to assess this probability, whereas the expert would be in a position, as far as possible, to provide scientific and statistical assistance enabling a better definition of loss of opportunity.     

Outpatient civil commitment of the mentally ill: An overview and an update

Civil commitment to outpatient psychiatric treatment has only recently become the subject of significant discussion, not only in the professional literature, but also in state legislatures and mental health departments. Task Forces from the American Psychiatric Association and the National Center for State Courts have drafted detailed reports on outpatient commitment, and a growing number of states have modified their statutes and regulations governing the process. The author presents the existing research literature on outpatient commitment in practice, reports recent statutory developments, and discusses specific areas of concern for those planning to propose or implement new procedures, including the right to refuse treatment, confidentiality, and the duty to warn or protect third parties.     

Black American Men's Treatment Experiences in Mental Health Court: A Phenomenological Analysis

In this qualitative study, the authors examined young adult Black American men's perceptions of treatment in mental health diversion programs. Findings included 3 themes: helpful treatment factors, cognitive dissonance, and treatment barriers. The authors explore counseling competency and advocacy considerations for judicial settings.     

Making mental health care decisions: Informed consent and involuntary civil commitment

This paper explores the development of the informed consent doctrine as it relates to psychiatric practice. The contribution of the issues of civil commitment and the right to refuse treatment to current developments in the informed consent doctrine is also addressed. Special informed consent issues are related to specific categories of psychiatric treatments. Basic in formed consent requirements in psychiatry are seen as still in the formative stages but the constitutional law and common-law foundations for further developments are outlined. The complicated clinical, ethical, and legal issues involved in modern psychiatric treatment are stimulating new interest and concern about the informed consent doctrine throughout medical practice.     

L’affaire Lambert et ses enjeux constitutionnels

Despite a great number of legal analyses concerning the Vincent Lambert Case, only few of them adopt a constitutional point of view. This lack questions the relevance of Constitutional Law to protect rights and liberties. That is particularly true concerning the matter of the end of life. The right to life and the patient's right to consent (and refuse) to a medical treatment are not specifically enshrined by French constitution, (set aside the simple right to live freely). Therefore, this legal vagueness may lead to various interpretations of the fundamental law, which could promote rights and liberties as a tool protecting one's life, as well as it may recognize a real right to die.     

Knowledge and success from ability

This paper argues that knowledge is an instance of a more general and familiar normative kind—that of success through ability (or success through excellence, or success through virtue). This thesis is developed in the context of three themes prominent in the recent literature: that knowledge attributions are somehow context sensitive; that knowledge is intimately related to practical reasoning; and that one purpose of the concept of knowledge is to flag good sources of information. Wedding these themes to the proposed account helps to explain a wide range of standard Gettier problems. It also helps to explain barn façade cases, which require a different kind of treatment.     

The right to refuse treatment in Oregon: A two-year statewide experience

The right to refuse treatment seems well established for psychiatric patients. Individual states, however, have very different procedures for managing this right and for overriding the refusal. Oregon's administrative procedure for override depends on an evaluation by an independent examining psychiatrist. This article empirically examines the 432 refusals leading to override requests in three Oregon psychiatric institutions in 1983 and 1984. Treatment refusal was found to be a common occurrence in all age groups. Those who refused treatment were seriously ill, unemployed, single individuals with previous psychiatric hospitalizations. Most refused treatment because of denial of their illness or delusional thinking about medication. Most refusals were overridden following the independent psychiatrist's examination. Because of the significant cost of the override procedure to the patient and the mental health system, the authors propose a new procedure which combines parts of the current procedure with a requirement that, at the time of the civil commitment hearing, the judge makes a separate decision as to the patient's competency to make treatment decisions.     

Protecting reasonable conscientious refusals in health care

Theoretical Medicine and Bioethics - Recently, debate over whether health care providers should have a protected right to conscientiously refuse to offer legal health care services—such as...     

Christian Pastors’ Perspectives and Insights on the Practice of Family Therapists Referring LGB Clients: Exploring the Role of Religion

Abstract

This qualitative study explored Christian pastors’ perceptions and insights for family therapists who refuse to work with lesbian, gay, and bisexual (LGB) clients by consistently referring them. Twenty-one pastors from diverse Christian traditions were interviewed. Thematic analysis identified the following themes related to the pastors’ perceptions of the practice of referring LGB clients: (1) Best Interest of the Client and Therapist, (2) Discriminatory Practice, and (3) No Referrals will be Provided. The following themes represent pastors’ advice for family therapists: (1) Develop a Well-Thought-Out Referral Plan; (2) Be Accountable for Your Own Beliefs; and (3) Engage in Conversations.     

Involuntary competence

This article addresses whether the state has the right to medicate involuntarily a defendant who is incompetent either to plead guilty or to stand trial for the purpose of restoring legal competence. It first presents the constitutional background concerning incompetence and the right of prisoners generally to refuse psychotropic medication. Then the article examines the individual and state interests that must be considered to decide specifically whether the state may involuntarily medicate a criminal defendant solely for the purpose of restoring competence. Although the individual interests are strong, the article contends that the state does have a right to medicate involuntarily defendants charged with most crimes to restore trial competence, and that adequate remedies are available to ensure that medicated defendants receive a fair trial.