Treatment Refusal

Management of treatment refusal can be legally and ethically complicated. Patients may refuse various types of treatment, including medications, group and individual psychotherapy, electroconvulsive therapy (ECT), and surgical procedures. Historically, patients with mental illness have had limited rights to refuse treatment. This chapter explores the factors that led to an increased recognition of these rights and provides an overview of current legal approaches to the adjudication of treatment refusal. It focuses primarily on the refusal of antipsychotic medications in inpatient settings, because many of the original court cases and much of the literature and research pertain to this issue. However, restrictions on the administration of antipsychotic medication over the patient’s objection extend beyond inpatient settings to nursing homes, medical and surgical inpatient services, and psychiatric outpatient settings. The chapter also discusses refusal of ECT and presents recommendations for the clinical care of a patient who refuses treatment.