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Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an important right to refuse treatment case, are compared with models in other jurisdictions. In sum, few cases are reviewed; in almost all reviewed, the court overrides the patients' refusal. The case raises troubling implications about due process and quality of care.
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OBJECTIVE: This is the first study to assess clinical practices under one of the new duty-to-protect statutes, some version of which has been passed in many states. In 1985, California enacted a statute enabling psychotherapists to limit their liability when a patient makes a serious threat of violence by 1) making reasonable efforts to warn the victim of the threat and 2) notifying local police. METHOD: The authors examined all duty-to-protect notifications over a 5-year period in San Francisco by reviewing police and court records. RESULTS: Police received only 337 notifications, typically made by nondoctoral staff members at public facilities such as psychiatric hospitals and crisis clinics. Patients most commonly directed their threats toward family members. Of the patients who made threats resulting in notifications, 51% had prior arrest records, and 14% had subsequent arrests. Only 52% of the patients who made threats were civilly committed. CONCLUSIONS: The findings suggest that 1) clinicians rarely discharge the duty to protect in the manner specified by the law, 2) many patients whose threats result in notifications have extensive involvement with the criminal justice system, and 3) family intervention may have clinical relevance in many duty-to-protect situations.
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The purpose of this article is to describe the legal approach, and in particular, the specific statutory vehicle adopted by the U.S. with respect to unlinked anonymous screening, and to offer the U.S. approach as a possible model for those countries presently considering the implementation of unlinked HIV screening programs. Clear legal authorization for unlinked anonymous HIV testing is provided for by statute or regulation in the U.S. Federal regulations and various state laws specifically permit unlinked anonymous testing. Under these regulations and statutes, informed consent of a test subject is not required so long as testing is done for research purposes and the test results are not individually traceable to particular subjects.
OBJECTIVE: The frequency of compulsory admission varies widely across Europe. Although there has been some research on a nation-wide level, no work has been done to compare mental health legislation in different countries in relation to detention rates and to patients' perception of hospital detention. METHOD: Databases and government statistics were searched for regional, national and European data. Legal frameworks were compared and reviewed in relation to patients' and professionals' views. RESULTS: Nearly 20-fold variations in detention rates were found in different parts of Europe. Criteria for detention of the mentally ill are broadly similar when it comes to patients at risk to themselves or others. However different rules apply for involuntary treatment in the interest of the patient's health. CONCLUSION: Variations in detention rates across Europe appear to be influenced by professionals' ethics and attitudes, sociodemographic variables, the public's preoccupation about risk arising from mental illness and the respective legal framework.
OBJECTIVE: The authors' goal was to assess healthy individuals' attitudes toward five of the most prominent proposed safeguards regarding the consent process for research with adults unable to consent. METHOD: Telephone interviews were conducted with 246 individuals with a family history of Alzheimer's disease who had participated in clinical research. RESULTS: The majority of respondents said that they were willing to participate in research if they lost the ability to consent. Few completed a research advance directive. Many had discussed their preferences with their families, and the majority would allow their families to make research decisions for them. CONCLUSIONS: Enrolling individuals who are unable to consent in research that offers no potential for medical benefit is consistent with the preferences of at least some individuals. This suggests that such research should not be prohibited, provided there is sufficient evidence that it is consistent with the preferences of individual subjects. Requiring that such evidence be provided in a formal research advance directive may be unnecessarily restrictive. More research is needed to assess whether the findings in this group of subjects generalize to other groups.
Twenty-three states have enacted Tarasoff statutes applicable to psychiatrists. Since the first such statute was enacted in California in 1985, a significant number of courts in states with this and similar statutes have reviewed Tarasoff-type claims. This article reviews courts' analyses in 76 such cases. There were five basic categories identified, including cases that (I) did not reference the statute; (2) referenced the statute, but did not analyze it; (3) referenced the statute, analyzed it, and found it created a duty; (4) referenced the statute, analyzed it, but found it did not create a duty; and (5) referenced the statute in the context of testimonial privilege. Review of these cases revealed that even in states that have Tarasoff statutes, clinicians must continue to rely on their clinical and ethical judgment, rather than statutory guidance, when considering potential protective disclosures or future drafts of protective disclosure statutes.
Involuntary administration of antipsychotic medication to pretrial criminal defendants raises important and controversial questions. These questions arise especially with defendants who have been adjudicated as incompetent to stand trial and who require medication to be restored to trial-competency and return to face their pending criminal charges. This subject has been fiercely debated for decades, but it has received little empirical investigation. We review here the known empirical studies that have looked at the use of involuntary medication for this population of individuals. The following nine conceptual areas are explored: subject selection, definition of 'refusal' and related terms, frequency of refusal, characteristics of refusers, reasons for treatment, reasons for refusal, type and outcome of the review of the refusal, outcome of treatment in the hospital, and outcome of the criminal charges. Relevant findings are reviewed. Methodological limitations call for more research in this area.
As an important subsystem in the families of child welfare clients, siblings deserve greater attention. This article identifies gaps in our knowledge about siblings, notes social trends that call for increased responsiveness to their needs, and reviews social work and legal opinions concerning their separation in foster care. The perspectives of the two professions are compared, and implications for child welfare are considered.
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The law and policy relating to the civil commitment of mentally ill persons in the United States and Romania are currently undergoing significant changes. While many jurisdictions in the United States are moving towards increasing emphasis on various forms of outpatient civil commitment, Romania is contemplating a restructuring of its commitment procedures to conform to international principles of human rights and to resemble more closely the United States model of commitment and care. A comparison of the procedures and standards for the involuntary civil commitment of mentally ill persons under each system is, consequently, timely. This article begins with a discussion of how mental illness is defined and identified clinically in a cross-cultural context. The article then examines the legal meaning of mental illness in the civil context in the United States and Romania, focusing on the implications of these meanings for the civil commitment of persons deemed to be mentally ill. Current models, standards, and procedures for the civil commitment of persons deemed to be mentally ill are described, using schizophrenia as a case example. The article concludes with an analysis of the strengths and weaknesses of each system and the arguments that provide the basis for the current reform efforts.
Since the early 1970s the issue of euthanasia has been intensely debated in The Netherlands. Through these debates knowledge about medical practices involving the end of life was no longer confined to medical or legal quarters, but became public to a large extent. Following public opinion changes, the legal reaction to euthanasia changed. By prosecuting test cases the public prosecutors allowed the Dutch Supreme Court to formulate specific conditions in which euthanasia would go unpunished. The political debate about changing the criminal law, which still holds that euthanasia is a serious crime, developed at a much slower pace. Several extensive empirical studies were undertaken to gain valid knowledge about the medical practices. This article is concerned with a presentation of the various debates and the changes that took place in the fields of criminal law, politics, and medicine. The main conclusion is the hypothesis that a more open climate for medical practices concerning the end of life allows society to better control these practices.
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