Autonomy and the right to refuse treatment: patients' attitudes after involuntary medication

The courts' assumption that patients' refusals of treatment are based on autonomous decision making was evaluated by examining the opinions of 24 involuntarily medicated patients about their treatment. At discharge 17 patients felt that their treatment refusal had been correctly overridden by staff and that they should be treated against their will again if necessary. Patients who persistently disapproved of the decision to override their treatment refusal were highly grandiose, engaged in denial of psychotic proportions, and responded poorly to treatment. The results suggest that, for most patients, the decision to refuse psychotropic medication is a manifestation of the patient's illness and does not reflect autonomous functioning or consistent beliefs about mental illness or its treatment. Consequently treatment refusal should be considered primarily a psychotherapeutic issue and, in most cases, should be subject to clinical rather than judicial review.