Right to Refuse Treatment - Introduction
The right to refuse medical treatment is well established in medicine and in law in different countries. However, persons with mental health problems face significant obstacles in exercising this right, and can be at high risk of abuse or harm from unwanted psychiatric interventions.
The right to refuse medical treatment stems from the fundamental human right to self-determination and personal autonomy. The right also touches on a host of other, sometimes conflicting, rights such as the right to life and bodily integrity, freedom from torture and inhuman or degrading treatment, privacy, and others. The right to refuse treatment is not absolute, and in practice has to be balanced against other considerations. Thus, it can be overruled in order to preserve life, protect the third parties, as well as preserve the ethical integrity of the medical profession. But, generally, a person's right to refuse treatment, even when doing so can end his or her life, tends to override other considerations, unless the person is proven to be incapable of making the decision.
Although mental health problems in themselves are not a reason to assume a person lacks legal competence, persons with mental health problems are often in a disadvantaged position when refusing psychiatric treatment. Their decision-making capacity is questioned, and the right to refuse treatment can be disregarded based on the claims that they do not understand their own best interest, or for the protection of the rights of others. Advocates of the rights of psychiatric patients, as well as many psychiatric care providers, agree that some assumptions need reviewing, and more safeguards are needed to ensure that the right of psychiatric patients to refuse treatment is genuinely respected.
One of the most serious issues is the administering of psychotropic medication or testing new drugs without the patient's informed consent, or worse still, over his or her objection.
Additionally, people with mental health problems or intellectual disabilities continue to be treated in a discriminatory manner when it comes to family planning and terminating life, as the value of life with disabilities sometimes appears to be perceived as less than the value of life without disabilities. This raises the concerns of some advocates that forced sterilization and even non-consensual euthanasia may be applied to persons with mental disabilities, either overriding their wish to refuse such medical interventions or failing to obtain their informed consent.
In this section of the website, you will find information about issues around the right to refuse medical or psychiatric treatment by the people with mental disabilities, as well as relevant publications and reports, other useful links, and some of the identified best practices.
Selected Sources
Chemically Induced Psychosis Experiments: An Inhumane Paradigm in Psychiatric Research (2000) is Congressional Testimony submitted by Vera Hassner Sharav. It brings to public attention major medical ethics violations in government-funded research in which uninformed, vulnerable individuals are put at high risks without justification. As a result, such individuals have often suffered severe consequences, including losing their lives. It also specifically discusses research subjects with mental disabilities.
Refusing the Right to Refuse: Coerced Treatment of Mentally Disabled Persons, by Grant H. Morris of the University of San Diego School of Law, reviews legal devices deployed to deny mental health patients their right to refuse treatment.
The Right to Refuse Treatment, by Grace E. Jackson, reviews the constitutional basis for the patient's right to refuse medical treatment in case of a physical illness, and discusses specifics and restrictions of the right of a patient with a mental illness. The author calls for a review of some of the outdated or inaccurate assumptions that deprive patients with mental health illness of their right to refuse treatment.