Rivers v. Katz, 495 N.E.2d 337 (and Grassi v. Acrish)
Court: New York State Court of Appeals
Year of Decision: 1986
Read the full-text amicus brief (PDF, 406KB)
Whether involuntarily committed mental patients, who have not been formally adjudicated to be incompetent, can refuse antipsychotic medication
Medication (Right to Refuse)
A group of mental patients brought suit against the State of New York seeking declaratory and injunctive relief to prohibit the forced administration of antipsychotic medications. They alleged that in the absence of an emergency or judicial declaration of incompetence, involuntary administration of medication violated their right to determine their own treatment as well as their constitutionally protected liberty interests and their right to due process of law. The lower and appellate courts in New York held that involuntary psychiatric patients were per se incompetent to make treatment decisions and that there was no violation of due process because the patients had access to an administrative appeal.
APA submitted an amicus brief arguing that: (1) the decisions below were so factually and legally flawed that a remand for further consideration was appropriate; (2) involuntarily hospitalized patients have a federal constitutional right to refuse antipsychotic drugs, similar to the right voluntary patients have to refuse them so long as they have not been found incompetent or imminently dangerous to themselves or others; (3) while antipsychotic drugs are highly beneficial for many patients, they also have substantial side effects — thus implicating basic federal principles of individual autonomy that may only be outweighed by state interests when the patient is incompetent or is imminently dangerous to self or others; (4) no other state interests — including those of improving the patient's health, improving public health, maintaining institutional order and efficiency, and furthering professional ethics — are sufficiently compelling to justify the forcible administration of antipsychotic drugs over a patient's objection; and (5) the final decision whether to authorize long-term administration of antipsychotic drugs over a patient's objection should be made by a court.
The New York Court of Appeals, by unanimous vote, ruled that involuntarily hospitalized mental patients cannot be forcibly treated with antipsychotic drugs unless they are either imminently dangerous to themselves or others, or have been found by a court by clear and convincing evidence to be not only mentally ill, but also mentally incompetent to make a reasoned decision concerning medication. On the issue of substituted judgment of a decisionmaker, the court adopted a middle-ground position which requires a hospital to prove to a court by clear and convincing evidence that the proposed treatment is narrowly tailored to give substantive effect to the patient's liberty interest, taking into account all relevant circumstances — including the patient's best interests, the benefits to be gained from the treatment, the adverse side effects associated with the treatment and any less intrusive alternative treatments.