The Right to Refuse Treatment: Ethical Issues

To understand the emerging concept of the right to refuse treatment in mental institutions, several underlying ethical issues must be examined. For example, the right is limited by such factors as the competence of the patient, the distinction between apparent and real refusal of treatment, and the desirability of some balance between the state's police power and parens patriae power. The most difficult ethical problems arise when a mentally ill individual is competent and not dangerous, needs treatment, and yet refuses it. In addition, most problems concerning the right to refuse treatment occur in large, understaffed, and underfunded public institutions whose nature affects the alternative treatments available, the quality of life without treatment, and the subtle coercive elements associated with any total institution. The author discusses these and other ethical issues pertaining to justifications for the right, limits to the right, treatment setting, and the treatments themselves.