Refusal of Psychiatric Treatment in the Emergency Department: Court Decisions

January 10, 2024 | Health System Risk Management


After a series of lower court decisions that raised as many questions as they answered,* the U.S. Supreme Court ruled in 1990 that patients in state mental hospitals have the constitutional right to refuse treatment with antipsychotic drugs. This ruling applied to patients in acute care hospital settings as well. However, the court also gave states the right to override a patient's refusal as long as certain conditions were present and steps were taken.

The facts of the case were as follows: the plaintiff, Harper, was an inmate in the psychiatric unit of a Washington state prison who, while incarcerated, was treated against his will with psychotropic drugs. Before the drug regimen was instituted, he was afforded a premedication hearing before a hospital committee consisting of a staff psychiatrist, psychologist, and associate superintendent of the hospital. The committee concluded that Harper met the facility's criteria for involuntary treatment—that is, he posed a likelihood of serious harm to himself or others without treatment—and therefore approved the drug regimen. He was unrepresented, except by a nurse practitioner from the Washington State Reformatory who was appointed to assist him. The treatment decision was reviewed periodically over a four-year period until Harper filed suit in state court seeking to stop the forcible injections. He claimed that the failure to provide him with a judicial, rather than an administrative,...

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