ABSTRACT
Historically, the rights of mentally ill patients to refuse treatment have been limited compared to persons without mental illnesses. This was primarily the case for patients committed to psychiatric facilities, but also applied to some voluntary patients (Appelbaum 1994). Society granted psychiatrists the authority to determine the course of treatment for committed patients and, if necessary, to administer it over objections. This was the backdrop until the last quarter of the twentieth century. By now, virtually every jurisdiction recognizes some version of the right of persons with mental illness, whether committed or not, to refuse treatment. In order to understand current legal approaches to treatment refusal, it is necessary to unravel the factors that led to this dramatic change in the nature of doctor-patient relationships in psychiatric institutions. Along with developments in mental health case law, the evolution of the informed consent doctrine and public perception about the quality of care delivered in institutions all played important roles with respect to the currently recognized right to refuse treatment (Hoge, Appelbaum, and Geller 1989; Perlin 1993; Appelbaum 1994; Winick 1997).
