Friday the Vermont State Supreme Court clarified the rules on when the state can force patients at the Vermont State Hospital to take medications against their will, recognizing the patients' right to refuse the drugs.
"As long as patient can understand the consequences of refusing medication, the statute permits him to do so, even if refusing medication will be to his detriment," Justice Denise Johnson said for the unanimous court. "In other words, a person who is competent to make a medication decision within the meaning of the statute has the same right as any other person to refuse beneficial medication."
The issue of forcing mental health patients to take medications, even if they don't want to, has been an emotional one. The Legislature, after an passionate debate, approved a law in 1998 permitting involuntary medication for mental health patients.
Friday's case involving a 64-year-old man suffering from bipolar disorder and alcoholism was the first time the Supreme Court has decided one of the involuntary medication disputes. The justices overturned Family Court Judge Matthew Katz's decision ordering the medication, directing that he hear the case again.
The court said trial court judges must consider whether a patient is competent to decline medication, something that did not happen in the case involving a patient identified in the decision only as "L.A."
"The statute requires only that (a) patient appreciate those consequences, not that he make the best decision in light of those consequences, or that he agree with his psychiatrist," Johnson wrote.
Jack McCullough, who represented the patient on behalf of Vermont Legal Aid, said the decision was an important one because it would guide the 25 to 30 cases of involuntary medication Legal Aid handles each year.
"It's very significant," McCullough said. "Ever since we started,, the state essentially has argued whenever the patient doesn't agree with the hospital psychiatrist, that proves that they can't make a decision. The Supreme Court specifically says that's not the case. The state has to show something more than just disagreeing with your doctor to show you incompetent to make a decision."
Assistant Attorney General David Bond said he believed the court merely was saying to the Family Court that its findings in the case "were not sufficient on the issue of competency" and did not signify a broader policy decision.
The state recognizes there are some patients with mental illness who have such significant physical side effects to medications that they can rationally refuse medication, Bond said. "That would be the kind of thing that might support a medication refusal," he said.
Although Bond said he believed the court "overstates what we argued," the justices acknowledged that the requirements of the law makes decisions more difficult, but that was as the Legislature intended.
"The Family Court and the commissioner appear to assume that there is only one competent choice patient could make _ to follow his doctor's advice and accept medication," Johnson wrote. "Neither the court nor the commissioner attempt to discern what patient perceives as the consequences of his decision to refuse medication. If patient's disagreement with his psychiatrist were sufficient to find him incompetent, the Family Court would have to grant every petition for involuntary medication filed by the commissioner."
On the Net:
http://dol.state.vt.us/gopher_root3/supct/current/2005-368.op
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