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Discuss the case study of Rivers v. Katz – administration of anti-psychotic medication over a patient’s objection

In Rivers v. Katz, the NYS Court of Appeals held that a diagnosis of mental illness and an involuntarily hospitalized doesn’t mean that a patient lacks capacity to make decisions about anti-psychotic medications. The Court went on to rule that such medication can be administered without consent in an emergency, but otherwise a court must make a determination about the administration of anti-psychotic drugs where a patient refuses to consent.

After reading the attached case study, please comment and discuss:

1. What do you think about the Court’s definition of an emergency situation.?

2. What do you think about a judge deciding whether or not to medicate a patient over a patient’s objection, given that one or more physician likely testified regarding the patient’s lack of capacity and the need for the medication?

3. Does this practice/procedure/legislation result in Judges making clinical determinations, or is it necessary to protect the civil rights of patients?

4. Please also comment on the below comment made earlier and whether you agree or disagree and why:

“This case demonstrates artistry in the development and interpretation of law. I congratulate the court of appeal on crafting an astute litmus test for evaluating the capacity of a mentally ill person and the circumstances under which the State may be warranted in exercising its police power to forcibly medicated this person, especially where they have been involuntarily committed. The court of appeal held that only, in the case where a mentally ill patient presents a danger to himself or other members of society, or when he engages in dangerous or potentially destructive conduct within the institution, can a state excise police powers and administer a drug without consent or against the wish of the patient.

Every individual of adult years and sound mind have the fundamental right to determine what is done with their body and to refuse medication as per New York common law. Individual autonomy and free choice dictates that the individual has the final say in regarding medical treatment.

The conundrum presented in this case was whether a person who is mentally ill and who has been involuntarily committed: is implicitly impaired and incapable of making decisions; lacks the mental capacity to understand the consequences of their actions (including refusing treatment); or retains the right and capacity to consent and to refuse medication.

Evidence presented and accepted by the court indicates that mentally ill patients do not lose their rights to liberty and freedom by virtue of being mentally ill or involuntarily committed. for example, evidence proves that despite the presence of a mental illness, disagreement with the prescription of the psychiatrist does not equal incompetence. Many mentally ill patients retain the capacity to function in many areas even when other areas become impaired. A patient may be deemed incompetent by a court of law and retain capacity for medical decisions.

In my opinion, the litmus test provided by the the supreme court makes it easier for judges and facility administrators evaluate whether to forcibly medicate a mentally ill patient. Judges will rely on this guidance which should be bolstered by the opinions independent psychiatric, psychological and medical evidence in making a judgement on the capacity of a mentally ill patient to consent to or refuse treatment. This is doable and consistent with many other decision making processes in health and other disciplines.”

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