Legal "Treatment" Protection
for All of Us
Springfield IL State Journal-Register
I sent this in to Springfield's daily newspaper, the State Journal-Register,
after a local psychiatrist wrote a column advocating more power for shrinks
to force treatment on unconsenting patients. I hate to look for the law
to protect people, but when it comes down to a judge or a shrink, what
are you supposed to do?
In the State Journal-Register of October 13, 1991, Dr. Robert
Becker objected to the "intrusion of formal legal hearings into a process
of commitment and treatment of the mentally ill in the United States."
He suggested that psychiatrists should be allowed to impose risky treatments
on an unconsenting patient without obtaining a judicial order that the
patient's wishes can be ignored. Fortunately, the law does require such
judicial approval, and with good reason.
The frustration of dealing with a mentally disordered friend or relative
often leads people to accept whatever treatment suggestions medical personnel
make. Thus, Dr. Becker's argument may seem reasonable to those who assume
that doctors always know best and that mentally ill individuals have no
ability to express rational preferences. Despite the comfort that absolute
faith in doctors can bring us, however, the fact is that doctors are often
wrong. And even when they are right, patients often have good reasons
for choosing to act contrary to what the doctor prescribes.
In the case that Dr. Becker describes, a judge refused to allow him to
force electroconvulsive therapy (electric shock treatment) on "Ron," a
diagnosed schizophrenic. Dr. Becker believes that electroconvulsive therapy
is necessary to prevent Ron from making another suicide attempt. At the
court hearing, however, the state's attorney representing Dr. Becker's
position failed to adequately support the need for Ron to undergo such
risky treatment. Since the need was undemonstrated, the judge rejected
The judge's decision was correct regardless of whether or not Ron "needs"
this treatment. When the government locks us up, or takes away our property,
or orders medical treatment against our will, it must have a very good
reason for doing so, and that reason must be proven. This is true in the
case of individuals suspected of having committed crimes--most of whom
are in fact guilty, but some of whom are not. It is equally true in the
case of individuals suspected of being mentally ill--many of whom may
in fact be mentally disordered, but at least some of whom remain capable
of assessing their options and choosing among them.
Doctors are not infallible. The research evidence makes it clear that
psychiatrists frequently disagree among themselves about the diagnosis
of patients and about appropriate treatment, as anyone who has observed
an insanity trial is aware of. Predictions that a particular patient will
be dangerous or suicidal in the future are especially unreliable, and
the tendency is for doctors to significantly overpredict.
Dr. Becker notes that 10 percent of schizophrenics die by suicide. If
that figure is correct, it does indeed represent a serious problem. But
should 100 percent of schizophrenics be treated against their will when
90 percent of them will not in fact commit suicide? Perhaps. Perhaps not.
There are reasonable arguments on both sides of this complex moral issue.
Doctors, however, are not trained to answer moral questions. It
may be appropriate for doctors to diagnose and even to predict, but it
is not their job to decide what constitutes "enough" justification to
infringe on someone's liberty and free choice. That is why a neutral third
party--a judge--must listen to both sides and reach a legal conclusion.
Or even why it may be legitimate for a state legislature to resolve the
broader issue on a political basis, reflecting the values of the general
Whoever makes the decision, the final outcome reflects a value judgment,
not a medical one. In Ron's case, the judge insisted that Ron could not
be treated without the state showing good reason. The judge was right.