Toward a therapeutic jurisprudence analysis of medication refusal in the court review model

Abstract

A therapeutic jurisprudence analysis attempts to discern the role of legal proceedings, lawyers and judges in producing therapeutic or anti‐therapeutic consequences. This paper will attempt to use the therapeutic jurisprudence framework to analyze the legal and administrative aspects of court review as it was reported during a one year epidemiologic study of drug refusal. Characteristics of the review process, the effect on patient refusal, and the attitudes of treating psychiatrists are presented. To broaden the clinical context of the administrative findings, selected clinical characteristics of refusing patients, their attitudes toward mental illness, reasons for refusing medication and satisfaction with court review will be described. The discussion attempts to show how the initial administrative study findings may be interpreted in the broader context of their relationship to the achievement of therapeutic outcomes.

Treatment and refusal rights in mental health: Therapeutic justice and clinical accommodation.

“…The psychiatric objections to this right expressed today are muted in comparison with those of a decade ago and center predominantly on administrative inconvenience and the unnecessary dedication of resources under "rights-driven'' dueprocess models rather than on dire consequences to patients from not taking their medications. Advocates of the review panel model refer to this model's encouragement of negotiated settlements and strong clinician-patient relationships, as contrasted with the zerosum judicial process, which essentially precludes interaction other than by legal fiat (Zito, Vitrai, & Craig, 1993). A therapeutic effect of the internal clinical review panel mechanism, as opposed to judicial review of treatment refusal, on the self-actualization of mentally ill patients has been posited (Ciccone, Tokoli, G$, & Clements, 1993).…”

“…However, it is surmised that the threat of judicial review may encourage some institutional providers to forgo poten-tially beneficial treatment attempts for patients whose decisional capacity is uncertain, thus depriving those patients of useful treatments they might have received under other review models (Zito, Vitrai, & Craig, 1993). This forced treatment frequently prepares the patient for return to the community, provided that he or she continues taking the prescribed medication.…”

“…A therapeutic effect of the internal clinical review panel mechanism, as opposed to judicial review of treatment refusal, on the self-actualization of mentally ill patients has been posited (Ciccone, Tokoli, Gift, & Clements, 1993). Advocates of the review panel model refer to this model's encouragement of negotiated settlements and strong clinician-patient relationships, as contrasted with the zero-sum judicial process, which essentially precludes interaction other than by legal fiat (Zito, Vitrai, & Craig, 1993).…”

“…This forced treatment frequently prepares the patient for return to the community, provided that he or she continues taking the prescribed medication. However, it is surmised that the threat of judicial review may encourage some institutional providers to forgo potentially beneficial treatment attempts for patients whose decisional capacity is uncertain, thus depriving those patients of useful treatments they might have received under other review models (Zito, Vitrai, & Craig, 1993).…”