The information must include documentation of any expressed wishes of the patient regarding medication, including wishes expressed in a power of attorney, a living will, an advance health care directive or oral statements in conversations with relatives and friends that are significant persons in the patient's life as those conversations are remembered by the relatives and friends.
The Court's decision states that, "if the information gathered and documented by the visitor enables the court to find that the patient has expressed a prior competent desire not to be medicated, then the court may not authorize treatment."
"We conclude," the Supreme Court wrote, "that the Alaska Constitution's guarantees of liberty and privacy require an independent judicial determination of an incompetent mental patient's best interests before the superior court may authorize a facility like API to treat the patient with psychotropic drugs."
A number of other states have also ruled that the right to refuse psychotropic drugs is fundamental. For instance, in Rogers v. Commissioner of the Department of Mental Health, the Supreme Court of Massachusetts held that a committed mental patient could not be forcibly drugged with antipsychotics unless a court determined both that he was incompetent and would have consented to the drugs if he was competent.
The court emphasized that mentally ill patients have dignity and worth equal to other individuals and said that a committed patient is entitled to an independent judicial determination of whether the patient would have consented to receive psychotropic drugs.
In Rivers v Katz, the New York Court of Appeals found a person's right to control his medical treatment in state common law but went on to declare that "[t]his fundamental common-law right is coextensive with the patient's liberty interest protected by the due process clause of our State Constitution."
In our system of a free government, the court wrote, where notions of individual autonomy and free choice are cherished, it is the individual who must have the final say in decisions regarding medical treatment. If the court concludes that the patient lacks the capacity to determine his own treatment, it states:
"the court must determine whether the proposed treatment is narrowly tailored to give substantive effect to the patient's liberty interest, taking into consideration 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."
The Minnesota Supreme Court reached a similar decision in Jarvis v Levine and ruled that the constitutional guarantee of privacy "begins with protecting the integrity of one's own body and includes the right not to have it altered or invaded without consent. Commitment to an institution does not eliminate this right. When intrusive treatment is proposed, the 'professional judgment' of medical personnel insufficiently protects this basic human right."
Most recently, the Ohio Supreme Court ruled in Steele v. Hamilton County Community Mental Health Board that the state could forcibly medicate a mental patient only after a court had found, "by clear and convincing evidence, that:
(1) the patient does not have the capacity to give or withhold informed consent regarding his/her treatment, (2) it is in the patient's best interest to take the medication, i.e., the benefits of the medication outweigh the side effects, and (3) no less intrusive treatment will be as effective in treating the mental illness."
Given the nature and potentially devastating impact of psychotropic medications, the court said, "the right to refuse to take psychotropic drugs is fundamental."
This right, the court said, must extend "equally to mentally ill persons," so that the mentally ill are not treated "as persons of lesser status or dignity because of their illness."
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