Opinion ID: 3170831
Heading Depth: 2
Heading Rank: 1

Heading: The Medina Test Applies to Orders to Increase Medication Dosage

Text: Â¶10Â Â Â Â Â Â Â First, we agree with the court of appeals that Medina applies to orders to increase a patientâs medication dosage. Marquardt, Â¶ 7. The Medina test strikes the appropriate balance between the patientâs right to bodily integrity and the Stateâs interest in protecting the patient and others from harm resulting from the patientâs illness. See Medina, 705 P.2d at 973. Therefore, Medina applies to decisions to increase the dose of medication over a patientâs objection as well as decisions to forcibly medicate a patient in the first place. Â¶11Â Â Â Â Â Â Â Generally, a person has the right to bodily integrity, which includes the right âto participate in and make decisions about his own body.â Id. at 968. This right emerged from the law of battery and developed into the law of informed consent, which requires a patientâs consent prior to treatment. Id. A physician who treats a patient without the patientâs consent commits a battery and is liable for damages, ânotwithstanding the exercise of reasonable care in performingâ the treatment. Id. (quoting Bloskas v.Â Murray, 646 P.2d 907, 914 (Colo. 1982)). Â¶12Â Â Â Â Â Â Â Even though a patient has been involuntarily committed, he does not lose his right to bodily integrity. See Â§ 27-65-104, C.R.S. (2015); Medina, 705 P.2d at 969â70. Forcibly medicating a patient over his objection is a clear violation of the patientâs right to bodily integrity, regardless of his capacity to make a competent decision about his health care. Medina, 705 P.2d at 971. âIf anything, the state has a greater responsibility toward those who are unable to protect themselvesâ and should be cautious in overriding a patientâs right to refuse treatment. Id. We noted in Medina, however, that an âinvoluntarily committed and incompetentâ patientâs right to refuse treatment is not absolute. Id. âThe state clearly has a legitimate interest in effectively treating the illnesses of those placed in its charge and, as well, in protecting patients and others from dangerous and potentially destructive conduct within the institution.â Id. Â¶13Â Â Â Â Â Â Â To balance these interests, a physician who wishes to treat such a patient despite the patientâs objections must petition the court for an order to forcibly administer the medication. See Â§ 27-65-111(5), C.R.S. (2015). The physician or facility seeking the order bears the burden to show, by clear and convincing evidence, that the treatment is necessary. Â§ 27-65-111(1). Medina created the framework for determining whether a court may order a patient to be forcibly medicated. 705 P.2d at 969-73. Under Medina, the physician or facility must show by clear and convincing evidence: (1) that the patient is incompetent to effectively participate in the treatment decision; (2) that treatment by antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patientâs mental condition or to prevent the likelihood of the patientâs causing serious harm to himself or others in the institution; (3) that a less intrusive treatment alternative is not available; and (4) that the patientâs need for treatment by antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment. Id. at 973. Â¶14Â Â Â Â Â Â Â The People argue that this test should not apply to a decision to forcibly increase the dose of a medication. But we see no reason why Medina should not apply in this case. The decision to increase a medication dose and the decision to medicate in the first instance both require balancing the same interests. Under Medina, Marquardt would have the right to refuse to take any amount of Saphris until the physician obtained a court order to force him to take the medication. See 705 P.2d at 971. Similarly, he has the right to refuse to take a higher dose of Saphris. However, the State also has a valid interest in treating Marquardt and ensuring that he is not a threat to himself or others. These competing interests are no different than the interests at play when the State initially seeks to medicate a patient over his objection. The test laid out in Medina appropriately balances these interests. Â¶15Â Â Â Â Â Â Â Therefore, we see no reason to create a new test for orders to forcibly increase the dose of a medication that a patient is taking voluntarily at a lower dose. Medina applies to this case.