Opinion ID: 1894515
Heading Depth: 3
Heading Rank: 1

Heading: Intrusiveness of Neuroleptic Drugs

Text: One of the principal considerations in the Price holding that ECT was intrusive therapy was the risk of side effects and permanent damage to the patient. We noted: As the techniques increase in severity, so do the risks of serious and long-lasting psychological or neurological damage. Price, 307 Minn. at 260, 239 N.W.2d at 912 (footnote omitted). The court listed the risks of adverse side effects and the extent of intrusion into the patient's body and the pain connected with the treatment as factors to be considered in determining whether ECT or psychosurgery is necessary. Id. at 262-63, 239 N.W.2d at 913. Because the privacy interest protected was described by the court as the concept of personal autonomy, id. at 257, 239 N.W.2d at 910, a reasonable starting point in any analysis of intrusiveness would be the probable effects of the particular therapy on the patient's body. In the case of neuroleptics, the likelihood of at least some temporary side effects appears to be undisputed. The most common results are the temporary, muscular side effects (extra-pyramidal symptoms) which disappear when the drug is terminated; dystonic reactions (muscle spasms, especially in the eyes, neck, face, and arms; irregular flexing, writhing or grimacing movements; protrusion of the tongue); akathesia (inability to stay still, restlessness, agitation); and Parkinsonisms (mask-like face, drooling, muscle stiffness and rigidity, shuffling gait, tremors). Additionally, there are numerous other nonmuscular effects, including drowsiness, weakness, weight gain, dizziness, fainting, low blood pressure, dry mouth, blurred vision, loss of sexual desire, frigidity, apathy, depression, constipation, diarrhea, and changes in the blood. Plotkin, Limiting the Therapeutic Orgy: Mental Patients' Right to Refuse Treatment, 72 Nw.U.L.Rev. 461, 475-76 (1977) (footnotes omitted). See also Gutheil & Appelbaum, Mind Control, Synthetic Sanity, Artificial Competence, and Genuine Confusion: Legally Relevant Effects of Antipsychotic Medication, 12 Hofstra L.Rev. 77, 99-117 (1983); Gaughan & LaRue, The Right of a Mental Patient to Refuse Antipsychotic Drugs in an Institution, 4 L. & Psychology Rev. 43, 51-52 (1978). Many of these side effects can properly be described as relatively minor and of a temporary duration. However, on rare occasions, other more serious non-muscular side effects, such as skin rashes, ocular changes, cardiovascular changes and sudden death, have been documented. Plotkin, supra, at 476. A more serious concern with the use of neuroleptics is the possibility, acknowledged in this case, of the patient developing tardive dyskinesia. [3] Tardive dyskinesia is a neurological condition that is permanent and irreversible. No satisfactory treatment exists. It is characterized by involuntary muscle movements such as chewing, blowing, or licking motions, but may also involve involuntary movement of other areas of the body. While some cases are mild, tardive dyskinesia can be life-threatening. In extreme instances, speech may be incomprehensible, and swallowing and breathing may be seriously impaired. See Plotkin, supra, at 476-77. [4] The underlying rationale in the Price case holding that ECT was intrusive was our concern over the risk of permanent physical damage. Clearly, the risks of tardive dyskinesia alone, even if other temporary side effects are discounted, could warrant placing neuroleptics in the same category as ECT. [5] Other state courts have not been hesitant about classifying neuroleptics with ECT and psychosurgery as intrusive based primarily on their assessments of the drugs' potentially devastating side effects. For example, the Oklahoma Supreme Court classified neuroleptics as an organic therapy, along with ECT and psychosurgery, seeing all three as intrusive in nature and an invasion of the body. K.K.B., 609 P.2d at 749. Similarly, Massachusetts treated neuroleptics in the same manner we would treat psychosurgery or electroconvulsive therapy. Roe, 383 Mass. at 437, 421 N.E.2d at 53. As the court of appeals noted, the risks can and do vary greatly, depending on such factors as the specific drug used, dosage, duration of treatment, and age of patient. Jarvis, 403 N.W.2d at 308. In our view, however, the likelihood of some potentially devastating side effects is both sufficiently significant and well established to support a finding of intrusiveness. [6]