Opinion ID: 2631631
Heading Depth: 4
Heading Rank: 1

Heading: Importance of right to choose or reject medication

Text: In the past we have recognized that Alaska's constitutional rights of privacy and liberty encompass the prerogative to control aspects of one's personal appearance, [50] privacy in the home, [51] and reproductive rights. [52] We have noted that few things [are] more personal than one's own body, [53] and we have held that Alaska's constitutional right to privacy clearly ... shields the ingestion of food, beverages or other substances. [54] Because psychotropic medication can have profound and lasting negative effects on a patient's mind and body, we now similarly hold that Alaska's statutory provisions permitting nonconsensual treatment with psychotropic medications implicate fundamental liberty and privacy interests. [55] We are hardly the first court to reach this conclusion. A number of state supreme courts have declared that the right to refuse psychotropic medication is fundamental; we find their opinions to be both instructive and persuasive. [56] In Rogers v. Commissioner of the Department of Mental Health, the Supreme Judicial Court of Massachusetts held that a committed mental patient could not be forcibly medicated with antipsychotic drugs unless a court determined both that he was incompetent and that he would have consented to the administration of the drugs if he was competent. [57] Although the court's opinion relied on Massachusetts's statutory and common law, rather than on interpretation of the state constitution, the court emphasized the constitutional and common law origins of [e]very competent adult['s] ... right `to [forgo] treatment, or even cure, if it entails what for him are intolerable consequences or risks however unwise his sense of values may be in the eyes of the medical profession.' [58] The court further emphasized that mentally ill patients have dignity and worth equal to other individuals; on this basis, the court held that a committed mental patient is entitled to an independent judicial determination of whether the patient would have consented to treatment with psychotropic drugs. [59] And the court explicitly rejected the argument that a substituted judgment determination of this kind could safely be left to the treating doctors rather than the courts. [60] In Rivers v. Katz , the New York Court of Appeals similarly located 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. [61] It wrote, In our system of a free government, where notions of individual autonomy and free choice are cherished, it is the individual who must have the final say in respect to decisions regarding his medical treatment in order to insure that the greatest possible protection is accorded his autonomy and freedom from unwanted interference with the furtherance of his own desires[.][ [62] ] While acknowledging the state's police power to forcibly medicate mental patients in emergency situationsa situation not at issue in the case before usthe court held that in New York, decisions to forcibly medicate persons in all other circumstances must be made by the courts. [63] If the court concludes that the patient lacks the capacity to determine the course of his own treatment, the court must [then] 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. [64] The Minnesota Supreme Court reached a similar result in Jarvis v. Levine. [65] It held that Minnesota's 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. [66] Thus, in Minnesota, the forcible medication of a committed mental patient requires both a judicial finding of incapacity to give informed consent and a judicial hearing to determine the necessity and reasonableness of the treatment. [67] Most recently, the Ohio Supreme Court held in Steele v. Hamilton County Community Mental Health Board that the state could forcibly medicate a mental patient under its parens patriae authority 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. [68] Ruling that the right to refuse medical treatment is a fundamental right in our country, where personal security, bodily integrity, and autonomy are cherished liberties, the court emphasized that [t]hese liberties were not created by statute or case law ... [r]ather, they are rights inherent in every individual that find explicit protection under the Ohio Constitution. [69] Given the nature and potentially devastating impact of psychotropic medications [70] as well as the broad scope of the Alaska Constitution's liberty and privacy guaranteeswe now similarly hold that the right to refuse to take psychotropic drugs is fundamental; and we further hold that this right 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. [71] When no emergency exists, then, the state may override a mental patient's right to refuse psychotropic medication only when necessary to advance a compelling state interest and only if no less intrusive alternative exists. [72]