Am J Psychiatry 1980; 137:332-339
Copyright © 1980 by American Psychiatric Association
The psychiatrist's double bind: the right to refuse medication
MG Ford
The assertion of a patient's right to refuse medication places a
psychiatrist in a double bind because he or she knows that medication will
often greatly relieve mental disturbance. Delaying medication until the
patient is formally judged incompetent and a guardian appointed causes
discomfort for the patient, the physician, staff, and other patients. On
the other hand, forcing medication on a patient undermines the latter's
sense of autonomy and may interfere with his or her constitutional rights,
as a federal judge has ruled in the famous Boston State Hospital case. The
right to refuse medication presents a uniquely intriguing case study of a
need for accommodation between abstract constitutional concepts and
practical realities and has opened a profound legal and ethical debate
about the nature of "true freedom."
