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“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”
Universal Declaration of Human Rights
Mental Health & Human Rights
Patient's Right to Refuse
Forced drugging occurs on a regular basis within residential treatment facilities for mentally ill patients and also with patients as outpatients. Forced drugging occurs among school children in America’s schools as in the Teen Screen program, despite federal legislation that prohibits the coercion of parents to medicate their child as a condition for special services. Those who are for forced drugging content that the issue of safety supersedes the right of the individual to refuse treatment.
The US Supreme Court had ruled that the government may involuntarily administer antipsychotic medications to a mentally ill criminal defendant in order to render him competent to stand trial, "but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests."
The United States Supreme Court decisions of Youngberg v. Romeo, 102 S.Ct. 2452, U.S.Pa.,1982, Mills v. Rogers, 102 S.Ct. 2442 (1982) and Rennie v. Klein, 102 S.Ct. 3506 (Mem), U.S.,1982, have been widely interpreted as holding that federal constitutional safeguards involving a person's right to refuse psychiatric medications are mostly defined by state law and that federal protection is limited to whether the treatment is "a substantial departure from accepted professional judgment, practice or standards" (the "Professional Judgment" standard).
However, none of these decisions address the problem of invalid medical practice standards that are not supported by scientific evidence of improved mental functioning due to drug administration. Actually in contrast, depressed people are routinely given medications that the FDA has demanded be labeled with a black box warning that the medication will increase the likelihood of suicide and violent behavior. None of these Supreme Court Decisions actually address the human rights of the patient or the possibility of medical fraud, misdiagnosis, malpractice or greed on the part of those running psychiatric and mental health facilities. Nor has the pervasive influence, both political and financial, of the pharmaceutical industry been taken into account.
It is clear that the Supreme Court of the United States doesn’t regard the views of clinical Ph.D. psychologists as equal or as valid to M.D. psychiatrists. Psychiatrists have a drug license and primarily treat patients with drugs, psychologists use talk therapy and other methods like biofeedback and hypnosis to treat patients. The concept of parity for patients who want non drug therapy has not been considered by the court and instead a pro-drug mentality has prevailed. So as long as the psychiatrist is willing to treat the patient with a drug that other psychiatrists use - even if it is an "off label use" or an unapproved use or even still not even approved by the FDA and in clinical drug trials - the Supreme Court has through many court cases still considered that within the professional standard.
What is the real rationale to force drug experimentation on a patient and making them a ward of the court with no civil rights in order to use unapproved drugs on them or "off label" treatments with an FDA black box warning that the drug increases the risk of suicide and homicide? Why does the US court system not care if the medication forced on a patient under civil commitment, causes the patient to have racing homicidal thoughts or causes them to commit suicide?
The courts have routinely prevented disclosure of the adverse effects of these drugs through restriction of discovery and sealed records as well as the acceptance of secret out of court settlements. It would appear that the Supreme Court had in many decisions allowed forced drugging as long as most psychiatrists would drug a patient (the professional judgment standard).
This meant that most mental health patients did not have meaningful protections for their human rights. It meant that the mental patient has no legal right to their own brain or to prevent forcible coercion for the rest of their life so that they will provide a “meal ticket” and be a “cash cow” to the medical-pharmaceutical community. Do not underestimate the value of this mental patient for financial gain, as most facilities charge a base rate of $500 to $1,000 a day for care and that does not include treatments, diagnostic procedures and other therapies. There are also payments of increased housing costs borne by federal programs and increased charting for Medicaid and Medicare as well as targeted case management costs and social welfare payments billed to the federal and state taxpayer. There are also increased court costs as the patient becomes a ward of the court for the purposes of enforcing compliance with the forced drugging order and costs of court appointed attorneys and routine hearings on guardianship matters.
But in an important more recent Supreme Court decision, a more reasonable standard was proposed. In the Supreme Court case of Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174 (2003), the Supreme Court held and that the Professional Judgment standard never was supposed to apply to forced medication cases. While Sell is a competence to stand trial case, it is hard to see how a person facing forced drugging in the context of civil commitment has fewer rights.
See, Reevaluating Substantive Due Process as a Source of Protection for Psychiatric Patients to Refuse Drugs, Indiana Law Review, 1998, 31 INLR 937.
In Sell, the U.S. Supreme Court laid down the following constitutional guidelines:
1. The court must find that important governmental interests are at stake.
2. The court must conclude that involuntary medication will significantly further those concomitant state interests.
3. The court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.
4. The court must conclude that administration of the drugs is medically appropriate, i.e., in the patient's best medical interest in light of his medical condition. Myers v. Alaska Psychiatric Institute, S-11021, which was presented by Attorney Jim Gottstein, invalidated Alaska's forced drugging statute and required the court to find by clear and convincing evidence that in addition to all of the statutory criteria, the forced drugging is in the person's best interests and there are no less intrusive alternatives available.
Legal Cases -Right to Refuse Treatment App. of Pres. & Dir. of Georgetown., 118 U.S. App. D.C. 80, 331 F.2d 1000 (1964) Super. of Belchertown v. Saikowitz, 383 Mass. 728, 370 N.E.2d 417 (1977)
Guardianship of Richard Roe III, In Re, 383 Mass. 415, 421 N.E.2d 40 (1981) Rennie v. Klein, 720 F.2d 266 (3d Cir. 1983)
Rogers v. Commissioner, 390 Mass. 489, 458 N.E.2d 308 (1983)
Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028 (1990)
Myers v. Alaska Psychiatric Institute, S-11021 So finally there has been changes in attitudes and also court decisions in both federal and state courts and legislatures, towards respecting the right of individuals to refuse unwanted psychotropic medication and providing due process protections for the enforcement of this right.
In the legal case, Mills v. Rogers, 457 U.S. 291, 299 (1982), the Supreme Court recognized that the federal Constitution recognizes a liberty interest in avoiding the unwanted administration of antipsychotic drugs.
Much more recently, a court in this District ruled that the right to refuse unwanted medication is grounded in the individual’s right to be free from bodily intrusion. Brandt v. Monte, 626 F. Supp.2d 469, 486 (D.N.J. 2009) (citing Rochin v. California, 342 U.S. 165, 172-74 (1952)). The same court ruled that the right to refuse unwanted medication is further grounded in the individual’s right to autonomy and to exercise control over her mental faculties.
Brandt, 626 F. Supp.2d at 486 (citing Lawrence v. Texas, 539 U.S. 558, 562 (2003) (“Liberty presumes an autonomy of self that includes freedom of thought....”)).
Moreover, the Supreme Court has observed that psychotropic drugs are “mind altering,” Mills, 457 U.S. at 293 n.1, and “alter the chemical balance in a patient’s brain, leading to changes . . . in his or her cognitive processes.”
Harper, 494 U.S. at 229. See also Scott v. Plante, 532 F.2d 939, 946 (3d Cir. 1976) (“It is sufficient to recognize that the involuntary administration of drugs which affect mental processes, if it occurred, could amount, under an appropriate set of facts, to an interference with [a person’s] rights under the first amendment.”).
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Roosevelt- Excerpt from the speech "Citizenship In A Republic",
delivered at the Sorbonne, in Paris, France on 23 April, 1910