Clinical Perplexities in the Treatment of Treatment-Refusing Forensic Patients

  • P. Rodenhauser
Part of the Medicolegal Library book series (MEDICOLEGAL, volume 5)


For many, the right to refuse treatment in a forensic hospital is a contradiction in terms. Court systems require maximum security hospitals for the protection of society from the committed, psychiatrically ill individual whose rights to privacy and autonomy are thereby modified, yet the involuntary “patient’s” rights to privacy and autonomy are upheld by the courts in defense of treatment refusal. Court-committed patients are met on admission by a patient advocate who explains the treatment authorization form for signature — before the patient has contact with the admitting psychiatrist. Although the courts accept recommendations of competency to stand trial contingent upon continuation of antipsychotic medication [1], the same medications have been considered mind controlling [2] in support of the right to refuse treatment. The invasive nature of psychoses [2] has not been conceded by the legal system.


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  1. 1.
    Feldman HS (1976) Psychopharmacology and the law: a forensic psychiatrist’s viewpoint. J Clin Pharmacol 16: 577–580CrossRefGoogle Scholar
  2. 2.
    Gutheil TG (1980) In search of true freedom: drug refusal, involuntary medication, and “rotting with your rights on.” Am J Psychiatry 137: 327–328Google Scholar
  3. 3.
    Heller A (1979) Impact of Davis v. Watkins on Ohio forensic hospital practice. Bull Am Acad Psychiatry Law 7: 39–62Google Scholar
  4. 4.
    Rodenhauser P, Heller A (to be published) Management of forensic patients who refuse treatment — two scenarios. J Forensic SciGoogle Scholar
  5. 5.
    Wood Sir J (1982) The impact of legal modes of thought upon the practice of psychiatry. Br J Psychiatry 140:551–557CrossRefGoogle Scholar
  6. 6.
    Appelbaum PS, Gutheil TG (1980) Drug refusal: a study of psychiatric inpatients. Am J Psychiatry 137: 340–346Google Scholar
  7. 7.
    Dietz PE, Rada RT (1982) Battery incidents and batterers in a maximum security hospital. Arch Gen Psychiatry 39: 31–34CrossRefGoogle Scholar
  8. 8.
    Monahan J (1982) Clinical prediction of violent behavior. Psychiatric Ann 12: 509–513Google Scholar
  9. 9.
    Rofman ES, Askinazi C, Fant E (1980) The prediction of dangerous behavior in emergency civil commitment. Am J Psychiatry 137:1061–1064Google Scholar
  10. 10.
    Wilkerson CD, O’Connor WA (1982) Human ecology and mental illness. Am J Psychiatry 139: 985–990Google Scholar
  11. 11.
    Zusman J (1979) Against the right to refuse treatment. Adv Now 5:12–16Google Scholar
  12. 12.
    Ford MD (1980) The psychiatrist’s double bind: the right to refuse medication. Am J Psychiatry 137:332–339CrossRefGoogle Scholar
  13. 13.
    Appelbaum PS, Roth LH (1981) Clinical issues in the assessment of competency. Am J Psychiatry 138:1462–1467Google Scholar
  14. 14.
    Roth LH, Meisel A, Lidz CW (1977) Tests of competency to consent to treatment. Am J Psychiatry 134: 279–284Google Scholar
  15. 15.
    Gutheil TG, Shapiro R, St Clair RL (1980) Legal guardianship in drug refusal: an illusory solution. Am J Psychiatry 137: 347–352Google Scholar
  16. 16.
    Appelbaum PS (1982) Limitations on guardianship of the mentally disabled. Law and Psychiatry 33:183–184Google Scholar
  17. 17.
    Bryne G (1981) Conference report: refusing treatment in mental health institutions: values in conflict. Hosp Community Psychiatry 12: 255–258Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • P. Rodenhauser

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