If a treatment can improve your health, does that give the government the right to force it onto you?
asserted
that → improve → you
Should the state compel people with diabetes to take insulin, patients with hypertension to take their medications, or people with obesity to lose weight?
asserted
state → compel → weight
Most Americans would recoil at such proposals.
asserted
Americans → recoil → proposals
Yet when it comes to people diagnosed with psychiatric disorders, many people seem willing to make an exception.
asserted
people → come → exception
A physician who administers treatment to a competent adult against the patient's will violates one of medicine's most fundamental ethical principles: informed consent.
asserted
who → administer → principles
Why should that principle carry less weight when the doctor is a psychiatrist?
asserted
doctor → carry → weight
Yet in a recent City Journal article, Stephen Eide and Valerie Franchitti of the Manhattan Institute argue that public support for involuntary psychiatric treatment reflects a welcome recognition of its potential benefits.
asserted
support → argue → benefits
Strangely, the article entirely avoids the concept of informed consent.
asserted
article → avoid → consent
Where it acknowledges any limitations to involuntary treatment at all, it considers only the possibility that coercive treatment may increase stigma against mental illness.
uncertain
treatment → acknowledge → illness
A psychiatric diagnosis does not extinguish your right to control your body.
asserted
diagnosis → extinguish → body
Competent adults have the right to decide what substances they consume, which medical treatments they accept, and what risks they take, even when others consider their choices unwise or self-destructive.
asserted
choices → have → risks
As the psychiatrist Thomas Szasz wrote in 1997, "I oppose involuntary psychiatric interventions not because I believe that they are necessarily 'bad' for patients but because I oppose using the coercive apparatus of the state to impose psychiatric relations on persons against their will."
asserted
I → write → will
Eide and Franchitti write, "The public is right to suspect that involuntary treatment can be effective."
asserted
treatment → write → ?
They cite data from the New York State Office of Mental Health showing substantial reductions in hospitalization, incarceration, homelessness, substance abuse, and suicide attempts following enrollment under Kendra's Law, which mandates outpatient psychiatric treatment.
asserted
which → cite → treatment
Yet these data do not establish that coercion caused those improvements.
asserted
coercion → establish → improvements
Participants also received increased access to psychiatric services, case management, and other support.
asserted
Participants → receive → services
Without adequately separating the effects of those services from the effects of coercion itself, the reported improvements cannot establish that compulsory treatment was responsible.
asserted
treatment → separate → coercion
The authors also justify involuntary psychiatric treatment by citing subway attacks, mass shootings, and other violent incidents.
asserted
authors → justify → attacks
But there is a fundamental difference between holding people accountable for violating others' rights and confining them because they might become dangerous.
uncertain
they → be → them
Communities can enforce laws against assault, trespassing, and public nuisance without criminalizing homelessness or mental illness.
asserted
Communities → enforce → homelessness
Moreover, involuntary commitment to a psychiatric hospital or rehabilitation facility—sometimes for prolonged periods—deprives people of their liberty without a criminal conviction.
asserted
commitment → deprive → conviction
Although civil commitment involves judicial procedures and opportunities for review, continued confinement may depend heavily on mental health professionals' assessments of whether patients meet release criteria.
uncertain
patients → involve → criteria
As Szasz warned, coercive psychiatrists can thus function as "judges and jailers not physicians and healers."
asserted
psychiatrists → warn → judges
Severe mental illness can impair decision-making, sometimes profoundly, but diagnosis and incapacity are not the same.
asserted
diagnosis → impair → making
Even among psychiatric inpatients housed for severe mental illness, a meta-review of the research at BMC Psychiatry shows, most retain the capacity to make treatment decisions.
asserted
most → house → decisions
Outside of hospitalized patients, decision-making capacity is even higher.
asserted
capacity → hospitalize → patients
The legal scholar Elyn Saks, who has lived with schizophrenia, brings both personal experience and academic expertise to the debate over involuntary psychiatric treatment.
asserted
who → live → treatment
Having experienced involuntary hospitalization, physical restraints, and forced medication, Saks has questioned the assumption that mental illness justifies overriding patients' wishes.
asserted
illness → experience → wishes
In her book Refusing Care she examines the ethical and legal problems posed by involuntary hospitalization, forced medication, and physical restraints.
asserted
she → refuse → hospitalization
Saks and the psychiatrist Dilip Jeste have also reviewed empirical research on decision-making capacity among people with psychiatric and substance use disorders, analyzing how capacity varies among individuals and how clinicians can assess and enhance patients' ability to make informed decisions.
asserted
clinicians → review → decisions
Though the medical field has developed structured interviews with standardized scores for mental incapacity, doctors can disagree on assessment.
asserted
doctors → develop → assessment
Mental capacity is also decision-specific and time-specific, not a permanent status attached to a diagnosis.
asserted
capacity → attach → diagnosis
That same BMC Psychiatry review of the literature describes the impairments seen in psychosis as "temporal, identifiable, and responsive to interventions," such as presenting information in simpler terms.
asserted
review → describe → terms
Even when incapacity can be established, we must adhere to the principle of least restrictive intervention.
asserted
we → establish → intervention
Any intervention must be justified by the circumstances, limited to what is necessary, and designed to preserve as much individual freedom as possible.
asserted
what → justify → freedom
Compulsory treatment takes different forms, each imposing distinct restrictions on individual liberty.
asserted
treatment → take → liberty
Assisted outpatient treatment allows people to remain in the community but subjects them to a court order governing treatment.
asserted
people → allow → treatment
Involuntary inpatient commitment deprives people of their physical liberty through hospitalization, while forced medication goes further by overriding bodily autonomy.
asserted
medication → deprive → autonomy
So impaired decision-making capacity does not automatically justify confinement, let alone forced medication.
asserted
capacity → justify → confinement
Medication can reduce psychotic symptoms, and some psychiatric patients who initially refuse treatment later believe it helped them.
asserted
it → reduce → them
…and 14 more, not listed.
The Aporia
