- Non-Consensual Treatment Is (Nearly Always) Morally Impermissible.Mark J. Cherry - 2010 - Journal of Law, Medicine and Ethics 38 (4):789-798.Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients (1) to preserve the patient's best interests and (2) to restore the patient's autonomy. Such arguments specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighted against other factors. Varying by jurisdiction, legal statutes usually require, in addition, at least (3) that there exists the threat of harm to self or others. In this paper, I argue against embracing the first (...)
Disagreements with Cherry's Article
In Mark Cherry’s article “Non-consensual Treatment is (nearly always) Morally Adherent” he takes a Socratic approach to the issue of involuntary hospitalization and forced treatment of psychiatric patients. Cherry believes that non-consensual treatment does not reserve the patient’s best interest, fails to respect autonomy, and uses the idea of the mentally ill being a threat to others to violate their human rights. I will challenge these ideas by exploring the “thank you theory” as it is related to a wide range of mental illnesses and respect to patient best interest, pondering how the informed consent process can ever be seen as valid with a patient having no true sense of reality, and how never considering someone a threat until they already show violent behavior can result in tragedies occurring that could have been easily prevented.
Though it is true that non-consensual treatment of the mentally ill usually does not result in a “thank you” from the patients, addicts seem to be the exception. These patients are grateful after their treatment because their problem has been addressed. They may not have ever been able to make that decision for themselves. Someone else made it for them, and they were grateful for it. This would mean that the treatment actually was in the patient's best interest, and it fails to support the idea that the mentally ill do not say “thank you” after treatment is forced on them. There was an article in the New York Times written by a man with a mentally ill son. He believes that if his son was treated, he very well could be alive today. Is saving his life not more important than a “thank you”? Just because someone does not show gratitude does not mean that they are not glad they are alive or better. Nurses and doctors treat patients all the time, with the patients showing no gratitude in return. First responders break ribs saving lives by CPR, and patients want to press charges. That does not mean they should not have been treated. The father, Norman J. Ornstein, stated in the article, “But I do know that for many, treatment saves lives. The true insanity is that our laws leave those who suffer to fend for themselves.” Addicts are grateful that they were not left to fend for themselves, because if they were, they would likely still be addicts. When a mental illness can result in death, lifesaving treatment should be given.
Cherry also focuses on autonomy and believes the informed consent is not simply for the endorsement of autonomy, but for the respect of autonomy. This respect that people should have comes from the fact that he thinks control over one's own body is a right held more sacred than any other. The problem with this idea is that when a mentally ill patient has no sense of reality or of themselves, even if they were to give consent, it could almost never be informed. How could they possibly understand treatment options when they do not even know what is happening around them? Does that mean that if they were about to die, but could not consent to life-saving treatment because they were too manic to truly be informed that they should instead just die? Also does this mean we should almost never treat the mentally ill? Because the ones that are able to understand what is going on probably don't need to be treated as badly as the ones that are completely lost. It is a good idea in theory, but in reality those who need help will almost never receive it.
Cherry also believes that having a mental illness is not reason enough to suspect a person will harm others or themselves. The major flaw in this argument is that those who are dangerous would have a chance to completely wreak havoc before anyone ever took steps to help them and protect others from danger. A major example of this would be shootings. The mentally ill are usually the ones shooting up public places like schools and movie theaters. Hundreds of life could have been saved by now if those shooters had help before they showed how dangerous they were.
These are just a few examples of how his arguments can be challenged. The article is a great read, but I do not believe that all the scenarios are plausible. The mentally ill are complex and hard to understand. They need help desperately. (Nearly always) waiting to give them help until they ask for it seems like leaving them to fend for themselves to me.