The right of institutionalized psychiatric patients to refuse treatment

The author contrasts the "paternalistic" and the "civil libertarian" views of non-consensual treatment of institutionalized psychiatric patients. Citing court cases and relevant literature, he emphasizes that competent patients have the right to refuse treatment, even when this decision is considered foolish. Involuntary hospitalization need not imply incompetence to refuse treatment, and the determination of such incompetence should be subject to rigorous safeguards. The nature of psychiatric treatment and the institutional setting necessitates procedures to ensure that consent truly is voluntary and informed. For patients judged incompetent, the decision to treat without consent should be influenced by various considerations related to diagnosis, prognosis, and the nature of the proposed treatment.