The right to refuse treatment under Rogers v. Commissioner: Preliminary empirical findings and comparisons

Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an important right to refuse treatment case, are compared with models in other jurisdictions. In sum, few cases are reviewed; in almost all reviewed, the court overrides the patients ' refusal. The case raises troubling implications about due process and quality of care. The right of the psychiatric patient to refuse antipsychotic medication is ex-plicitly established in a number of juris-dictions.', * Even where such a right ex-ists the law usually permits involuntary treatment in emergency situations when the patient is imminently dangerous or, alternatively, when the patient is incom-petent to make treatment decisions. En-suing procedural requirements for deci-sion making vary widely. In Massachusetts the Rogers decision3 established the right of psychiatric pa-tients to refuse antipsychotic medication in nonemergency situations: some of the complex issues in this problematic de-cision are elsewhere detailed.4 The Rog-ers court held that incompetent patients must be reviewed in full adversarial hearings, in which a judge decides to accept or reject a proposed treatment plan, based on a substituted judgment as to what the patient would have wanted if competents; even those pa-tients clearly accepting antipsychotics must be competent to give informed consent to do so or else must undergo similar judicial review. This full judicial review was felt to be required because the Massachusetts Supreme Judicial Court elected to portray antipsychotic medications as highly risky, thus requir-ing extensive procedural sanction^.