Opinion ID: 1679694
Heading Depth: 1
Heading Rank: 2

Heading: to determine competency to refuse medication

Text: [1-3] We are asked to determine whether § 51.61(1)(g)4, Stats., provides one standard to determine if a patient is competent to refuse medication. The analysis requires the interpretation of a statute, which is a question of law. State ex rel. Hodge v. Turtle Lake, 180 Wis. 2d 62, 70, 508 N.W.2d 603 (1993). Questions of law are decided ab initio by this court. Id. When interpreting statutes, we first look to the language. Village of Shorewood v. Steinberg, 174 Wis. 2d 191, 201, 496 N.W.2d 57 (1993). If that language is clear and unambiguous, our inquiry ends, and we must simply apply that language to the facts of the case. Id. It is only when the language is ambiguous that we resort to judicial construction to ascertain and carry out the legislative intent. Id. When the circuit court and the court of appeals concluded that Virgil was not competent to refuse medication under § 51.61(1)(g)4 because he did not have an appreciation of his mental illness, they ignored the plain language of the statute and created another test for competency which the statute neither articulates nor intends. Section 51.61(1)(g)4 unambiguously provides only one standard in order to assess a patient's competency to refuse medication: the patient must be able to express an understanding of the risks and benefits of, and the alternatives to, medication. Section 51.61(1), Stats., defines patient as any individual who is receiving services for mental illness, developmental disabilities, alcoholism or drug dependency, including any individual who is admitted to a treatment facility in accordance with this chapter or ch. 55 or who is detained, committed or placed under this chapter or ch. 55 . . Once a patient has been admitted or committed to a treatment facility, he or she must be informed of his or her rights, both orally and in writing. Section 51.61(1)(a), Stats. Section 51.61(1)(g) outlines a patient's rights with regard to the refusal of medication or treatment: (1) A patient may refuse all medication and treatment except when it has been ordered by the court due to the patient's incompetence or when medication is necessary to prevent serious physical harm to the patient or others. See §51.61(1)(g)1, Stats. (2) Prior to a final commitment order, the court may hold hearings to determine whether the patient is competent to refuse medication or treatment; an assessment of incompetence may result in the administration of medication, regardless of the patient's consent. See §51.61(1)(g)2, Stats. (3) Following a final commitment order, a patient has the right to exercise informed consent with regard to all medication and treatment, unless the patient has been shown to be not competent to refuse medication or treatment or if the medication is required to prevent serious physical harm to the patient or others. See § 51.61(1)(g)3, Stats. (4) A patient has the right to refuse medication or treatment if he or she is able to express an understanding of the advantages and disadvantages of, and the alternatives to, accepting medication or treatment. See § 51.61(1)(g)4, Stats. [4] As a direct result of this court's holding in Jones v. Gerhardstein, 141 Wis. 2d 710, 733-35, 416 N.W.2d 883 (1987), the legislature created subsections 3 and 4 of §51.61(1)(g), granting a patient subject to a final commitment order the same right to refuse medication as a patient detained pending a final commitment hearing. [6] Contrary to the plain meaning of the statute, the court of appeals concluded that sub. 4 of § 51.61(1)(g) is merely illustrative of one way by which a court may determine that a patient is not competent. We conclude that the statute clearly establishes only one standard to evaluate a patient's competency to refuse medication, that is, whether the patient is able to express an understanding of the advantages and disadvantages of, and the alternatives to, accepting medication or treatment. The sole focus of the statutory language is upon the patient's understanding of the effects of a particular medication, not upon that patient's acceptance of the diagnosis of a mental illness. [5] Therefore, before a circuit court can find that a patient is not competent to refuse medication, it must be satisfied by clear and convincing evidence [7] that the patient is incapable of expressing an understanding of the risks and benefits of, and the alternatives to, the proposed medication or treatment.