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Damage Remedies and Institutional Reform: The Right to Refuse Treatment

Published online by Cambridge University Press:  27 April 2021

Extract

The articulation by a court of a new constitutional norm serves a valuable function: the right, as elaborated by judicial opinion, provides a standard for critically evaluating current social practices. The “right to refuse treatment,” that “newly created constitutional right of personal autonomy,” draws attention to the problems of institutionalized mental patients and their desires to make their own decisions to accept or reject drug therapies, particularly where severe side effects are involved. The enunciation of the right to refuse treatment, with its hard-edged overtones, forces us to look at the tension created by the conflict between institutional attempts to treat these patients, the sometimes antithetical desire of those within the institution to control them without regard for treatment impact, and the patient's desire to retain whatever control is left to him in such settings.

The right to refuse treatment-like its common law analogue in tort, informed consent doctrine-draws its roots from concepts of personal autonomy that pervade both tort doctrine and constitutional law.

Type
Article
Copyright
Copyright © 1982 American Society of Law, Medicine & Ethics

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References

Fiss, O.M., Foreword: The Forms of Justice, Harvard Law Review 93 (1):1, 52 (November 1979).Google Scholar
Friendly, , The Courts and Social Policy: Substance and Procedure, University of Miami Law Review 33:21 (1978).Google Scholar
See Gavison, , Privacy and the Limits of the Law, Yale Law Journal 89:421, 449 (1980).Google Scholar
Rogers v. Okin, 478 F. Supp. 1342 (D. Mass. 1979), 634 F.2d 650 (1st Cir. 1980), vacated sub nom., Mills v. Rogers,____ U.S. _____ (1982). After this article was written, the Supreme Court remanded the case to the First Circuit for a determination of whether a right to refuse treatment with psychotropic drugs exists under Massachusetts law. The Court did not decide whether such a right exists in federal law, and therefore did not reach the issue of damages.Google Scholar
Rogers v. Okin, 478 F. Supp. 1342, 1365 (D. Mass. 1979).Google Scholar
Id., quoting Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417, 426 (Mass. 1977).Google Scholar
Rogers v. Okin, 634 F.2d 650, 653 (1st Cir. 1980).Google Scholar
See Stone, , The Right to Refuse Treatment, Archives of General Psychiatry 38(3): 358 (March 1981).Google ScholarPubMed
Carey v. Piphus, 435 U.S. 247 (1978) (plaintiffs were high school students awarded nominal damages only, for deprivation of due process when they were suspended from school).Google Scholar
Id. at 254.Google Scholar
Id. at 258.Google Scholar
Id. at 259.Google Scholar
Id. at 258.Google Scholar
See, e.g., Halperin v. Kissinger, 606 F.2d 1192 (D.C. Cir. 1979) (denial of Fourth Amendment rights through electronic surveillance; proof of actual damages are not required because of the nature of the interests involved).Google Scholar
Wood v. Strickland, 420 U.S. 308, 318 (1974).Google Scholar
Gomez v. Toledo, 446 U.S. 635 (1980).Google Scholar
Rogers v. Okin, supra note 6, at 1382–83.Google Scholar
See Nichols v. Layman, 506 F. Supp. 267 (N.D. Ill. 1980) (change in law on constitutional right to treatment).Google Scholar
Bailey v. Lally, 481 F. Supp. 203 (D. Md. 1979) (unclearness of law on use of prisoners for medical experiments); Saffron v. Wilson, 481 F. Supp. 228 (D.D.C. 1979) (lack of clarity of rules governing demonstration near the White House).Google Scholar
Wood v. Strickland, 420 U.S. 308, 322 (1974).Google Scholar
McCray v. Burrell, 622 F.2d 705 (4th Cir. 1980) (failure to notify psychologist about bizarre behavior of inmate after placing him in solitary).Google Scholar
Rogers v. Okin, supra note 6, at 1382.Google Scholar
Id. at 1382, quoting from Downs v. Sawtelle, 574 F.2d 1, 12 (1st Cir. 1977), cert. denied, 439 U.S. 910 (1978).Google Scholar
Rogers v. Okin, supra note 6, at 1383. For a discussion of the effects of the litigation upon the operation of the Austin Unit at Boston City Hospital by the unit's director, see Gill, M.J., Side Effects of a Right to Refuse Treatment Lawsuit in Refusing Treatment in Mental Health Institutions—Values in Conflict (Doudera, A.E. Swazey, J.P., eds.) (AUPHA, Ann Arbor) (1982).Google Scholar
“Like frontline surgeons, they were required to work with what they had… . [I]t would be unjust and unreasonable for courts to hold psychiatrists personally and individually responsible for resource deficiencies that are actually the responsibility of society.” Id. at 1385.Google Scholar
Dobbs, D., Handbook on the Law of Remedies §§ 3.1, 7.3 (1973) [hereinafter cited as Dobbs].Google Scholar
Id. at §7.3.Google Scholar
One court following Carey v. Piphus has allowed presumed damages in a case involving a prisoner incarcerated in a segregated jail. In Mickens v. Winston, 462 F. Supp. 910 (E.D. Va. 1978), aff’d mem. 609 F.2d 508 (4th Cir. 1979), the court concluded that “although plaintiff has failed to vocalize, with any specificity, his alleged injury, confining his testimony to ‘feeling bad,’ by virtue of defendant's intentional policy of racial segregation, the court concludes he was presumptively injured, for which he is entitled to a monetary award.” 462 F. Supp. at 913.Google Scholar
Brooks v. Moss, 242 F. Supp. 531, 532 (W.D. S.C. 1965) ($3,500 compensatory award for police assault includes element for “deprivation of rights as a citizen”). One commentator has suggested that Congress set a fixed minimum recovery to effectuate the presumed damage remedy. See Note, Damage Awards for Constitutional Torts: A Reconsideration after Carey v. Piphus, Harvard Law Review 93 (5): 966, 989 and n. 141 (March 1980).Google Scholar
Dobbs, , supra note 32, at §3.8.Google Scholar
Cochetti v. Desmond, 572 F.2d 102 (3rd Cir. 1978).Google Scholar
Carey v. Piphus, supra note 11, at 257 n.11.Google Scholar
Restatement (Second) Torts, §8 A (1965), defining “Intent: The word ‘intent’ is used to … denote that the actor desires to cause the consequences of his act, or that he believes that the consequences are substantially certain to result from it. …”Google Scholar
See Fountila v. Carter, 571 F.2d 487 (9th Cir. 1978) ($5,000 punitive award based on $1 actual injury overturned).Google Scholar
Dobbs, , supra note 32, at §2.9.Google Scholar
See e.g., Zarcone v. Perry, 572 F.2d 52 (2nd Cir. 1978); Silver v. Cormier, 529 F.2d 161, 163 (10th Cir. 1976); Spence v. Staras, 507 F.2d 554 (7th Cir. 1974); Basista v. Weir, 340 F.2d 74 (3rd Cir. 1965).Google Scholar
See Cochetti v. Desmond, supra note 38, at 105–06: “The availability of punitive damages as a deterrent may be more significant than ever today, in view of the apparent trend of decisions curtailing the powers of federal courts to impose equitable remedies to terminate such [constitutional] violations.” See generally Love, J.C., Damages: A Remedy for the Violation of Constitutional Rights, California Law Review 67 (6): 1242, 1275, n.274 (a typical range of punitive damage awards, from $250 to $10,000, is set forth).Google Scholar
478 F. Supp. at 1381.Google Scholar
634 F.2d at 662.Google Scholar
See Harper, James, , The Law of Torts, vol. 1, §5.30 at 468–70 (1956); Caperci v. Huntoon, 397 F.2d 799 (1st Cir.), cert. denied, 393 U.S. 940 (1968).Google Scholar
Imbler v. Pachtman, 424 U.S. 409, 442 (1976) (White, J., concurring).Google Scholar
Carey v. Piphus, supra note 11, at 265. See Nahmod, S., Civil Rights and Civil Liberties Handbook §4.02 at 96 (1979).Google Scholar
Note, Damage Awards for Constitutional Torts: A Reconsideration after Carey v. Piphus, Harvard Law Review 93 (5): 966, 968 (March 1980).Google Scholar
Carey v. Piphus, supra note 11, at 265.Google Scholar
Rogers v. Okin. supra note 8, at 660.Google Scholar
Rennie v. Klein, 476 F. Supp. 1294, 1307-15 (D.N.J. 1979).Google Scholar
Id. at 1312.Google Scholar
Mills, M.J., The Continuing Clinicolegal Conundrum of the Boston State Hospital Case, Medicolegal News 9(2): 9 (April 1981).Google ScholarPubMed
See Brooks, A., The Constitutional Right to Refuse Antipsychotic Medications, Bulletin of the American Academy of Psychiatry & the Law 8(2): 179 (1981).Google Scholar
See generally Whitman, C., Constitutional Torts, Michigan Law Review 79 (1): 5, 4852 (1980).Google Scholar
For a discussion of “general deterrence,” see Calabresi, G., The Costs of Accidents (Yale Univ. Press, New Haven) (1970) at 135–97.Google Scholar
Cass, R.A., Damage Suits Against Public Officers, University of Pennsylvania Law Review 129 (5): 1110, 1139 (1981).Google Scholar
Halderman v. Pennhurst State School & Hospital, 446 F. Supp. 1295, 1307 (E.D. Pa. 1977).Google Scholar
Brooks, , supra note 56, at 189.Google Scholar
See Caffrey, et al, Discontinuation or Reduction of Chemotherapy in Chronic Schizophrenics, Journal of Chronic Disability 17(4): 347 (1964).Google Scholar
See Huth, , Mind Medicine's Side Effects: Are the Risks Worth the Cure? Washington Post, April 9, 1972 at B-3, col. 1.Google Scholar
See Brooks, , supra note 56, at 188.Google Scholar
The control of symptoms may not even have a therapeutic purpose in some cases, since the symptomatic behaviors may be preferred by the patients to the sedative effects of the neuroleptic drugs. Van Putton, Crumpton, Yale, , Drug Refusal in Schizophrenia and the Wish to be Crazy, Archives of General Psychiatry 33(12): 1443 (December 1976).Google Scholar
Gaughan, LaRue, , The Right of a Mental Patient to Refuse Antipsychotic Drugs in an Institution, Law and Psychology Review 4:43 (1978).Google Scholar
Marholin, Phillips, , Methodological Issues in Psychopharmaceutical Research, American Journal of Orthopsychiatry 46(3): 477 (July 1976).Google ScholarPubMed
See Brooks, , supra note 56, and discussion in Rennie v. Klein, , supra note 53.Google Scholar
See Group for the Advancement of Psychiatry publication, Pharmaco-Therapy and Psychotherapy: Paradoxes, Problems and Progress, at 173–74 (1975).Google Scholar
See Klein, , Who Should Not be Treated with Neuroleptics But Often Are, in Rational Psychopharmacotherapy and the Right to Treatment (Ayd, F., ed. 1974). See also Carpenter, McGlashan, Strauss, , The Treatment of Schizophrenia without Drugs: An Investigation of Some Current Assumptions, American Journal of Psychiatry 134(1): 14 (January 1977); Klawans, Goetz, Perlik, , Tardive Dyskinesia: Review and Update, American Journal of Psychiatry 137(8): 900 (August 1980).Google Scholar
Dr.Cole, Jonathan, quoted in Sobel, Something Nasty at the Bottom of the Psychiatric Drug Bottle, New York Times, June 8, 1980, at 20F.Google Scholar
See Brooks, , supra note 56, at 202 (evidence that the level of use of the psychotropic drugs dropped off dramatically in the New Jersey state hospitals after the Rennie decision).Google Scholar