Nurses and nurses' aides probably administer almost all the medications in most large mental institutions. Until recently it was generally assumed that whatever drug the physician ordered, the nurse had to administer and the patient had to accept. Two recent cases, however, have challenged these assumptions and may lead to major changes in the way mental patients are treated.

There are two basic justifications for confining the mentally ill: (1) to protect them or other members of society — the so-called “police power” justification; and (2) to care for those unable to care for themselves — the parens patriae justification. Both generally require use of the “least restrictive alternative.” Mentally ill patients may or may not be competent to make any number of decisions, including the decision to accept or reject medications; but when can they be forcibly treated?