Respect for the Values and Preferences of Mental Patients: the Medina Trilogy
| Publication year | 1982 |
| Pages | 3014 |
1982, December, Pg. 3014. Respect for the Values and Preferences of Mental Patients: The Medina Trilogy
People in the Interest of Medina, decided by the Colorado Court of Appeals on September 23, 1982, is an enlightened, fresh look at the issue of whether enforced medication of an institutionalized mental patient should be allowed in a non-emergency situation. The Medina "trilogy" refers to the Medina case and two closely related cases which give depth to the holding of Medina: People in the Interest of Luft, in which the patient held a summa cum laude degree in psychology and sociology, and In re Herbert S. Dveirin, in which the patient was a psychiatrist. In all three cases, the patients were under long-term certification at Fort Logan Mental Health Center and were given anti-psychotic medication without the patients' consent and over the patients' objections.(fn1)
Since 1978, the right of mental patients to refuse medication has been recognized and sustained in several states.(fn2) Since 1979, the guiding case in Colorado has been Goedecke v. Department of Institutions,(fn3) which basically required the trial court to find that the patient's mental illness impaired his judgment so that he lacked the capacity to participate in decisions affecting his health or that his refusal to accept medication at that time was irrational and unreasonable. Since these findings were missing in the trial court's determination, the Supreme Court remanded the case.
The Goedecke court did not specifically reach the important issue of whether an emergency must be present in order to justify involuntary drug treatment. However, on June 18, 1982, the U.S. Supreme Court in Mills v. Rogers(fn4) remanded a Massachusetts case on the enforced medication issue in light of another Massachusetts case decided while the U.S. Supreme Court appeal was pending.(fn5)
The Luft case is the most telling example of a non-emergency situation. A Stay of Execution was granted pending appeal and the patient essentially got well without the treatment.(fn6) The state doctor testified under cross-examination that there were some studies that showed that some patients with the same illness would improve on their own and that the rate of improvement, percentage-wise, was the same regardless of whether psychotropic drugs were used.(fn7)
In the Medina case, the patient, without anti-psychotic medication, suffered frequent headaches (helped by ordinary headache remedies), was agitated, had outbursts of assaultive behavior and suffered delusions. The court deemed these symptoms not to be of an emergency nature. The Medina three-judge panel unanimously held:
Absent an emergency situation calling for immediate action (in which event the least intrusive means should be used by the physician to meet the emergency), antipsychotic medication shall not be administered to a mentally incompetent patient who has not given his consent to this medication unless ordered by a court following a proper hearing.(fn8)
The Medina factors which should be included in a proper hearing include the following.(fn9)
---urgency of decision
---extent of impairment of the patient's mental faculties
---patient's level of understanding...
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