Lloyd I. Sederer, M.D.
Adjunct Professor, Columbia/Mailman School of Public Health
Medical Editor for Mental Health, Huffington Post/AOL
All patients have both a right to treatment and a right to refuse treatment. These rights sometimes become the centerpiece of debate and dispute for people who are hospitalized with an acute psychiatric illness.
There is a long legal history on the right to treatment. Much of the law derives from court cases in the previous century involving people who were admitted to state psychiatric hospitals where they languished without proper treatment, sometimes for many years. Laws compelling a right-to-treatment law developed and became instrumental to the quality-controlled public psychiatric hospitals that exist today. In fact, in order for public psychiatric hospitals to receive Medicare and Medicaid (and other third-party) payment, they must obtain the same national certification as academic medical centers and local community hospitals. For patients and families, this means that a person admitted to a public psychiatric hospital has a right to receive—and should receive—the standard of care delivered in any accredited psychiatric setting.
The Right to Refuse Treatment
It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.
Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital. But a person admitted involuntarily, due to danger to self or others, cannot leave, at least not right away. However, despite having the authority to keep the patient in the hospital, the professional staff cannot treat the person against his or her will, except by court order.
The concept of a right to refuse treatment was built on basic rights to privacy, equal protection under the law, and due process. In other words, involuntarily hospitalized patients still have a right to decide what happens to their bodies.