Treatment refusal by dangerous patients

Abstract

Recently psychiatric patients in Canada and the United States who are admitted to mental hospitals involuntarily have been granted the right to refuse treatments recommended to them. As a result, significant numbers of dangerous and mentally disturbed patients are being detained in hospitals without receiving therapy for the serious problems that brought them to hospital and keep them there. They receive custodial rather than clinical care. This civil libertarian approach incurs significant social and financial costs and raises important moral questions about the management of unwilling mental patients who are deemed dangerous to society. This article discusses six patients who were detained without treatment in a maximum security mental hospital in Ontario, Canada. The article describes a management approach for dangerous patients who refuse psychiatric drugs and other treatments offered to them. The authors suggest that competence to consent to psychiatric treatment should require the capacity to appreciate long-term as well as immediate consequences of accepting or refusing treatment.