Medina: Incompetence and the Right to Refuse Medication
| Publication year | 1985 |
| Pages | 1998 |
| Citation | Vol. 14 No. 9 Pg. 1998 |
1985, November, Pg. 1998. Medina: Incompetence and the Right to Refuse Medication
The recent decision of the Colorado Supreme Court in People in the Interest of Medina(fn1) extends to involuntarily committed and incompetent mental patients the same qualified right to refuse treatment with anti-psychotic medication first recognized in 1979 in Goedecke v. Colorado Department of Institutions.(fn2) Goedecke established the existence of a common law right to decline treatment with anti-psychotic medication on the part of involuntarily committed mental health patients. These patients must be presumed to be competent to participate in treatment decisions unless there has been a judicial determination that the patient is incompetent to do so.
In Medina, the Colorado Supreme Court articulated a four-part test to guide trial courts in their conduct of medication hearings. This reflects an underlying philosophical choice by the court in favor of the "best interests" approach to right to refuse medication cases, rather than the "substituted judgment" approach which had been adopted by the Court of Appeals.(fn3) The decision settles several questions left unanswered by Goedecke, and seems to establish a standard of review which should be flexible enough to accommodate the varying circumstances of individual cases without sacrificing either the patient's due process concerns or the state's interest in providing good treatment to those who need it. However, an unintended effect of the right to refuse medication may be to deprive people of needed treatment unless there is a greater commitment to providing the resources necessary for the mental health system to treat patients effectively.
The Supreme Court concluded in Medina that, unless there is an emergency which poses an immediate and substantial threat to the life or safety of the patient or others in the institution, anti-psychotic medicine may be administered to a non-consenting mentally ill patient incapable of making an informed treatment decision only after a trial court conducts an adversary hearing on the treatment decision and is satisfied by clear and convincing evidence that:
(1) the patient is incompetent to participate effectively in the treatment decision;
(2) treatment by anti-psychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient's mental condition or to prevent the likelihood of the patient's causing serious harm to himself or others in the institution;
(3) a less intrusive alternative is not available; and
(4) the patient's need for treatment by anti-psychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment.
The respondent, Joseph P. Medina III, a thirty-four-year-old with a long history of mental illness and assaultive behavior, had been placed by the Department of Institutions in Fort Logan Mental Health Center for long-term treatment pursuant to court order. The Denver City Attorney's office alleged in a motion filed in the Denver Probate Court that the staff psychiatrists at Fort Logan had determined that anti-psychotic medication would be beneficial to Medina, but that he had been refusing the medication over a period of several days. The motion asserted that the respondent had a history of violent behavior both in and out of institutions, remained a danger to himself and others, and was becoming increasingly agitated and psychotic as a result of his unmedicated state. The motion asked the court to enter an order authorizing treatment of the respondent by use of anti-psychotic medication over the patient's objection.
The treating psychiatrist, whose testimony was the only evidence elicited at the hearing, testified that the respondent suffered from severe paranoid schizophrenia, which rendered him psychotic most of the time. When psychotic, the psychiatrist testified that Medina heard voices which caused him to be confused and angry and that he suffered from paranoid fantasies that people were about to harm him. He sometimes became assaultive during these episodes and occasionally attacked others or threw furniture and other objects around the mental health facility. The psychiatrist testified that Thorazine enabled the respondent to gain control over some of
The treating physician also testified that if the respondent were to continue regular does of the medication, he could eventually be placed in a...
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