In re Bryant

582 A.2d 1216
Brief Filed: 6/87
Court: District of Columbia Court of Appeals
Year of Decision: 1988

Read the full-text amicus brief (PDF, 380KB)

Issue

Whether involuntarily committed mental patients have the right to refuse anti-psychotic medication

Index Topic

Medication (Right to Refuse)

Facts

Bryant was an individual with a long history of mental illness and numerous involuntary hospitalizations. When released from the hospital, Bryant frequently refused to take psychotropic medication, an action that usually led to her readmission to the hospital. During an involuntary admission, Bryant refused medication that was then administered against her will. Under the District of Columbia law and regulations, the attending physician was required to obtain the approval of a hospital review board before administering psychotropic drugs to a patient who refused voluntary medication. The review board would apply a "best interests of the patient" standard rather than a substituted judgment standard and, unless the patient's objection was religiously based, the hospital board determination would not be reviewable in court. Bryant moved for a protective order prohibiting the involuntary administration of psychotropic medications. At a hearing, the Superior Court heard evidence both that Bryant's refusal of medication was due to a delusional belief that she was God and God did not need drugs and that Bryant, although schizophrenic, was capable of making rational treatment decisions. The Superior Court held that Bryant was incompetent to make treatment decisions and declined to prohibit involuntary administration of psychotropic medication. The court held that, although Bryant would face a high risk of developing tardive dyskinesia, psychotropic medication offered the only hope for Bryant's eventual return to the community. Applying a substituted judgment model, the court concluded that Bryant would not refuse medication if she were competent. Finally, the court held that, apart from a religious-based objection, an involuntarily committed mental patient has no substantive or procedural rights with respect to the forced administration of psychotropic medication and Bryant was not making a sincere religious objection to medication. The case was appealed to the District of Columbia Court of Appeals.

APA's Position

APA submitted an amicus brief arguing that (1) the court should recognize the right of a competent mental patient, under the common law or the Constitution, to refuse psychotropic drugs; (2) an involuntarily committed patient has a right to a judicial determination of incompetence prior to any involuntary administration of psychotropic drugs; and (3) a patient judged incompetent has the right to a substituted judgment determination, made by a court rather than a physician, as to whether the patient would have refused the medication if competent.

Results

The District of Columbia Court of Appeals limited its ruling to the fact that Bryant was granted a hearing and a court had made a substituted judgment on her behalf. The fact that the hearing and determination came after the forced administration of psychotropic medication was not considered by the court.