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

Heading: Best-interests criteria

Text: Having determined that courts must engage in best-interest inquiries, we believe that some discussion is in order concerning appropriate criteria to guide courts on this issue. Evaluating whether a proposed course of psychotropic medication is in the best interests of a patient will inevitably be a fact-specific endeavor. At a minimum, we think that courts should consider the information that our statutes direct the treatment facility to give to its patients in order to ensure the patient's ability to make an informed treatment choice. [92] As codified in AS 47.30.837(d)(2), these items include: (A) an explanation of the patient's diagnosis and prognosis, or their predominant symptoms, with and without the medication; (B) information about the proposed medication, its purpose, the method of its administration, the recommended ranges of dosages, possible side effects and benefits, ways to treat side effects, and risks of other conditions, such as tardive dyskinesia; (C) a review of the patient's history, including medication history and previous side effects from medication; (D) an explanation of interactions with other drugs, including over-the-counter drugs, street drugs, and alcohol; and (E) information about alternative treatments and their risks, side effects, and benefits, including the risks of nontreatment[.][ [93] ] Considering these factors will be crucial in establishing the patient's best interests as well as in illuminating the existence of alternative treatments. [94] And here, too, we find the work of other state courts to be helpful. The Supreme Court of Minnesota has held that in order to determine the necessity and reasonableness of a treatment, courts should balance [a] patient's need for treatment against the intrusiveness of the prescribed treatment. [95] Factors that the Minnesota court believed should be considered included: (1) the extent and duration of changes in behavior patterns and mental activity effected by the treatment; (2) the risks of adverse side effects; (3) the experimental nature of the treatment; (4) its acceptance by the medical community of the state; and (5) the extent of intrusion into the patient's body and the pain connected with the treatment.[ [96] ] We find these approaches to be sensible. Finally, we note that the parties have disputed the standard of proof that the state should be required to meet in establishing the patient's best interests. API argues for a preponderance of the evidence standard, but it offers no legal authority to support that position. Other courts that have required best-interests determinations in this area have uniformly adopted the clear and convincing standard. [97] Moreover, our existing statutory scheme already adopts this standard for findings required to authorize psychotropic medication. [98] We see no reason to dilute the standard governing the best-interests determination, and hold that the clear and convincing evidence standard controls the issue.