Thursday, October 19, 2000

Mentally ill must take medicine


Case began here when patient refused drugs

By Spencer Hunt
Enquirer Columbus Bureau

        COLUMBUS — The Ohio Supreme Court on Wednesday gave doctors greater powers to force drugs on mental patients who are unwilling or unable to make a decision to take them.

        The 7-0 decision creates new rules trial judges must use to weigh a person's basic right to “say no” against a doctor's desire to help him get better. It was a setback to patient-rights groups, which had urged the high court to approve a tougher standard.

        The case began in 1998 when a patient at Cincinnati's Pauline Warfield Lewis Center refused to take an anti-psychotic drug for his schizophrenia. Although Jeffrey Steele later decided to take the medication, Haldol, the court system continued to wrestle with the overall question of forced medications.

        An opinion written by Justice Andrew Douglas is meant to provide a clear and final answer.

        “The right to refuse medical treatment is a fundamental right in our country, where personal security, bodily integrity, and autonomy are cherished liberties,” wrote Justice Douglas. “The right to refuse medication, however, is not absolute and it must yield when outweighed by a compelling governmental interest.”

        Critics said the ruling means more patients will have to take anti-psychotic drugs that have severe, and sometimes permanent, side effects. Those effects include restlessness, drowsiness, involuntary shaking and drooling.

        “These drugs are toxic,” said Shannon Smith, Mr. Steele's attorney. “Some of these people believe they are actually being poisoned.”

        A. Norman Aubin, an attorney representing the Hamilton County Community Mental Health Board, praised the decision. He said it will help more mental patients get better.

        The justices upheld a legal practice in which a doctor can medicate a patient who poses an immediate threat to himself and others. The doctor also must determine that the drugs are the best and only way to eliminate that threat.

        The decision also lets a doctor forcefully treat a patient who is nonthreatening. To do this, a doctor must first prove three things in court:

        • The patient is unable to make an informed decision.

        • No other treatment would be as effective.

        • The drugs are in the patient's best interest, outweighing the side effects.

        Judges must appoint an independent psychiatrist and a physician to examine each case. Patients could hire their own attorneys and experts, and appeal any decision.

        These rules mirror guidelines already used by some county courts in Ohio.

        Mr. Smith had hoped to persuade the high court to follow a tougher standard that Hamilton County courts and others have followed. That rule bars all forced medications except in cases where a patient is a threat or declared incompetent after a hearing.

        “It's going to be harder to keep (mental patients) from being forcefully medicated,” Mr. Smith said.

        An official at the Ohio Legal Rights Service, a state agency that defends the rights of physically and mentally impaired people, said he'd reserve judgment until new forced-drug cases work their way through county courts.

        “You have the potential, arguably, for the rubber-stamping of medical decisions,” warned Michael Kirkman, the agency's legal director.

        Though he agreed with most of the high court ruling, Justice Paul Pfeifer said the decision went too far, and addressed important legal questions that were not raised in Mr. Steele's case.

        “I am troubled by the notion that involuntarily committed mentally ill patients will have their lives greatly altered by potentially dangerous drugs with little recourse in the legal system,” he wrote in a separate opinion.

        Silent throughout the case is Mr. Steele. Mr. Smith was unable to confirm his client's location or condition. According to their policy, officials at the Pauline Warfield Lewis Center also would not confirm whether he was a patient there.

       



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