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Right to refuse treatment: impact of Rivers v. Katz
J R Ciccone1, J F Tokoli, C D Clements
1Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York 14642.
The Bulletin of the American Academy of Psychiatry and the Law
|January 1, 1990
Summary
The Rivers v. Katz decision shifted psychiatric treatment refusal from medical review to judicial determination. This led to fewer patients refusing medication but increased the time to resolve treatment disputes.
Area of Science:
- Psychiatry
- Law
- Public Health Policy
Background:
- Involuntarily committed psychiatric patients often refused psychopharmacologic treatment.
- Prior to 1986, a medically administered review process handled treatment refusals.
Purpose of the Study:
- To examine the impact of the New York court decision, Rivers v. Katz, on the procedure for managing psychiatric patients who refuse medication.
- To analyze the clinical, legal, and economic implications of the post-Rivers procedure.
Main Methods:
- Analysis of state procedures for responding to treatment refusal by involuntarily committed patients before and after the Rivers v. Katz decision.
- Review of clinical, legal, and economic outcomes associated with the judicial determination process.
Main Results:
- The Rivers v. Katz decision replaced medical review with judicial determination and "substituted judgment."
- Following the decision, the rate of patients consistently refusing treatment decreased.
- The time from patient refusal to resolution of the treatment dispute increased.
Conclusions:
- The Rivers v. Katz ruling significantly altered the legal framework for psychiatric treatment refusal.
- The new procedure resulted in fewer consistent refusals but prolonged the resolution process.
- The study discusses the multifaceted implications of this legal shift in psychiatric care.