Question

Case: Forcible Administration of Medications.

Answer 1

Introduction:
Forced medication is the commonest method used on psychiatric wards to control mentally ill patients who are violent toward others or to themselves.

Definition:
Forced medication defined as 'administration of oral or intramuscular medication against the patient's will during emergencies, which is not part of the regular treatment'.
As the administration, regardless of seclusion or restrain,of a rapid transquilizer. By temporarily restricting the patient's freedom of movement, it is intended to control his or her behaviour in a way that reduces the risk to their own safety or that of others.

Rights of the patients:
Mental health patients possess the same human rights as all other individuals in the world. Patient has rights to refuse treatment. According to both international and national law, they should be treated as citizens entitled to community support. Mental health facilities have a duty to care for patients in a humane, respectful manner. However, in practice, they are granted unbounded discretionary power to force vulnerable patients to take medication whenever staff believe it is appropriate.

Requirements for Forcible Medications:

The Supreme Court’s decisions, involving criminal defendants seeking to refuse antipsychotic medication, seem to suggest a form of strict scrutiny. To justify the administration of antipsychotic medication, the Court required a finding that the involuntary medication was medically appropriate and the least intrusive means of accomplishing one or more compelling governmental interests.

When a criminal defendant seeks to refuse medication that the government contends is required to restore or maintain his or her competency, the criminal court will need to hold a hearing on whether these standards are satisfied and to make specific factual findings concerning them before medication may be imposed.

The Supreme Court applied a reduced form of constitutional scrutiny to uphold the involuntary administration of antipsychotic medication in a prison hospital for an inmate who was found to be dangerous to other prisoners and staff. In prison contexts, as long as the medication is medically appropriate and reasonably related to the need to protect others from harm and to protect prison security, it may be imposed even if less restrictive alternatives, such as solitary confinement, might suffice to protect others from violence. Outside the prison context, however, involuntary medication will need to be justified as necessary to accomplish one or more compelling governmental interests.

An informed decision of Substitute decision-maker ( SDM):

Person incapable of consenting to treatment, a substitute decision-maker (SDM) interested in his/her welfare will make a treatment decision on his behalf.

Law- United States:
All states in the U.S. allow for some form of involuntary treatment for mental illness or erratic behavior for short periods of time under emergency conditions, although criteria vary. Further involuntary treatment outside clear and pressing emergencies where there is asserted to be a threat to public safety usually requires a court order, and all states currently have some process in place to allow this.
Under assisted outpatient commitment, people committed involuntarily can live outside the psychiatric hospital, sometimes under strict conditions including reporting to mandatory psychiatric appointments, taking psychiatric drugs in the presence of a nursing team, and testing medication blood levels. Forty-five states presently allow for outpatient commitment.
   However, the involuntary treatment of minors remains legally permitted in most states, usually with the consent of a parent or guardian. The use or purported overuse of psychotropic drugs on minors has exploded in recent years, and this fact has received some increased attention from the public, legal experts, people who have received treatment, as well as medical researchers concerned over long-term effects on development.

The effects of forced medication on individuals with Schizophrenia and Manic-depressive illness:

   Patients with psychiatric disorders refuse medications for a variety of reasons, including experience with, or fear of, side effects. In other cases, the refusal is based on lack of awareness of illness or on delusional beliefs. Many such patients must ultimately be medicated involuntarily. Studies suggest that the long-term effects of involuntary medication on individuals with schizophrenia and manic-depressive illness (bipolar disorder) are more positive than is commonly thought. In most studies, the majority of patients retrospectively agreed that involuntary medication had been in their best interest.

There was a high correlation between patients who believed they had a mental illness and those who found the guardianship helpful. although a majority of the patients were against enforced treatment in principle, often because they thought it conflicted with their civil rights, most found the actual experience, including medication, to be helpful.

Professional Ethics:

Judges, attorneys, and clinicians called on to act in the forcible medication context, thus, should understand that they function as therapeutic agents in the way they treat the individual who seeks to resist unwanted medication. Judges and clinicians involved in involuntary treatment therefore should treat patients fairly, with dignity and respect, and accord them a sense of participation in the decision-making process.

Rather than resisting the patient’s right to refuse treatment, clinicians should understand that recognition of such a right and the patient’s participation in treatment decision making can present therapeutic opportunities.