311: Morals & Medicine
MENTAL HEALTH INVOLUNTARY TREATMENT
LAW IN THE U.S.
Normally, FOUR STEPS are involved for involuntary treatment or
Determination of mental disorder. A typical law defines a
mental disorder as, "Any organic, mental, or emotional impairment
which has substantial adverse effects on an individual's cognitive
(thought) or volitional (action) functions." Involuntary confinement
and treatment for purposes of mental evaluation are limited to 72
hours. This initial step requires confinement that is ordered and
supervised by a licensed mental health professional.
Within 72 hours of initial confinement, a court must find that
it is necessary to protect the person or the public, or to
facilitate effective treatment for treating the person. This court
finding can permit involuntary confinement or treatment for a
limited time (usually 2 weeks or 30 days), after which another court
finding can extend it. Indefinite time periods are NOT permitted.
The physician must choose among the least restrictive treatment
alternatives necessary to protect the individual and the public and
permit effective treatment.
There must be public notice of the reasons why confinement or
involuntary treatment was chosen from among the other alternatives.
There are specific criteria for commitment for mental evaluation.
HARM TO SELF:
A substantial risk of serious harm indicated by threats
(written or verbal) or attempts to commit suicide or inflict
physical harm on one's self.
HARM TO OTHERS:
Behavior that has caused harm or places others in reasonable
fear of sustaining harm. Can be written, verbal, or actual
Behavior that has already taken place that has caused substantial
loss or damage to the property of others.
Behavior that results in the individual being in danger of serious
physical harm resulting from the failure to provide for his/her
needs of health and safety or, the individual has shown a
deterioration in routine functioning which is evidenced by a
repeated and escalating loss over his/her actions and is not
receiving necessary care for health and safety needs.
ETHICAL PROBLEM: Three of the four criteria are
However, preventive confinement is immoral when
directed at mentally competent people.
Furthermore, competent people have the right to refuse
treatment even if it is in their best interests to have it.
TONY HOPE: To allow preventive confinement & involuntary treatment is
UNJUST, because it treats persons with mental disorders differently.