involuntary treatment

File:Man in restraint chair; by H. Clarke; 1869 Wellcome L0019069.jpg

In the early 20th century, many countries passed laws allowing the compulsory sterilization of some women. In the US more than half the states passed laws allowing the forced sterilization of people with certain illnesses or criminals as well as sterilization based on race.{{cite journal |vauthors=Patel P |date=2017-07-14 |title=Forced sterilization of women as discrimination |journal=Public Health Reviews |volume=38 |issue=1 |pages=15 |doi=10.1186/s40985-017-0060-9 |pmc=5809857 |pmid=29450087 |doi-access=free }} Forcible sterilization took place in the United States until at least 1981,{{cite web |date=15 November 2002 |title=State will admit sterilization past |url=https://news.google.com/newspapers?id=ZFBWAAAAIBAJ&sjid=jesDAAAAIBAJ&pg=6596,4132204 |archive-url=https://web.archive.org/web/20160107221309/https://news.google.com/newspapers?id=ZFBWAAAAIBAJ&sjid=jesDAAAAIBAJ&pg=6596,4132204 |archive-date=7 January 2016 |work=Portland Oregonian |vauthors=Sullivan J}} more than 64 thousand people were forcibly sterilized.{{cite web |title=Eugenic Sterilization Laws |url=http://www.eugenicsarchive.org/html/eugenics/essay8text.html |work=Eugenics Archive |vauthors=Lombardo P}} Denmark sterilized 60 thousand people between 1935 and 1976.{{Cite news |date=August 29, 1997 |title=Denmark to investigate its involuntary sterilization program |work=AP News |url=https://apnews.com/article/e1731db26be41810f79e7e148d087a04 |vauthors=Olsen J}} During Nazi rule in Germany as part of their eugenics program about 600 thousand people were compulsorily sterilized.{{cite web |title=The connection between American eugenics and Nazi Germany, James Watson |work=DNA Learning Center |url=https://www.dnalc.org/view/15466-The-connection-between-American-eugenics-and-Nazi-Germany-James-Watson.html |url-status=live |archive-url=https://web.archive.org/web/20140221173441/http://www.dnalc.org/view/15466-The-connection-between-American-eugenics-and-Nazi-Germany-James-Watson.html |archive-date=2014-02-21 |access-date=2014-02-05}} |"The connection between American eugenics and Nazi Germany" James Watson speaks about Nazi eugenics

Involuntary euthanasia was carried out in Nazi Germany for those who had certain psychiatric disorders or learning disabilities as part of the Aktion T4 program.{{cite journal |vauthors=Strous RD |date=January 2006 |title=Nazi euthanasia of the mentally ill at Hadamar |journal=The American Journal of Psychiatry |volume=163 |issue=1 |pages=27 |doi=10.1176/appi.ajp.163.1.27 |pmid=16390885}} This program was run by Karl Brandt, a medical doctor, and Philipp Bouhler.{{Cite book |url=https://www.worldcat.org/oclc/54860099 |title=The origins of the Final Solution: the evolution of Nazi Jewish policy, September 1939-March 1942 |vauthors=Browning CR |date=2004 |publisher=University of Nebraska Press |others=Jürgen Matthäus |isbn=0-8032-0392-6 |location=Lincoln |oclc=54860099}}{{Rp|page=185}} Victims were murdered together in gas chambers and this program was a prototype for the extermination camps such as Auschwitz where the Holocaust took place.{{cite report |title=The "Euthanasia" of People with Disabilities in Nazi Germany: Harbinger of the "Final Solution" |vauthors=Young R}} As part of Action 14f13, physicians involved in the euthanasia program visited concentration camps where they looked at documentation provided by SS camp doctors and approved the murder of camp inmates on the grounds of race, behavior and ability to work using the euthanasia program's facilities.{{Rp|page=192}}

Throughout the latter half of the 20th century, homosexual men in the UK were given the choice between chemical castration with female sex hormones or prison including, notably, Alan Turing.{{cite journal |vauthors=Smith G, Bartlett A, King M |date=February 2004 |title=Treatments of homosexuality in Britain since the 1950s--an oral history: the experience of patients |journal=BMJ |volume=328 |issue=7437 |pages=427 |doi=10.1136/bmj.328.427.37984.442419.EE |pmc=344257 |pmid=14751920}}

Until 2004, every European state required that transgender people must be sterilized or provably infertile to have their preferred gender formally recognized.{{cite journal |vauthors=Dunne P |date=November 2017 |title=Transgender Sterilisation Requirements in Europe |journal=Medical Law Review |volume=25 |issue=4 |pages=554–581 |doi=10.1093/medlaw/fwx028 |pmid=28575446|hdl=1983/f36734ac-1bd7-41f3-9b0e-db64e94afc8f |hdl-access=free }}{{Rp|7}} This practice continued in Sweden until 2012{{Cite news |date=2013-01-14 |title=Transgender People in Sweden No Longer Face Forced Sterilization |magazine=Time |url=https://newsfeed.time.com/2013/01/14/transgender-people-in-sweden-no-longer-face-forced-sterilization/ |access-date=2021-04-07 |issn=0040-781X |vauthors=Nelson R}} and Denmark until 2014.{{cite news |date=22 May 2018 |title=OVERBLIK: Transkønnedes kamp mod lovgivningen |language=da |work=avisen.dk |url=https://www.avisen.dk/overblik-transkoennedes-kamp-mod-lovgivningen_499227.aspx |url-status=live |access-date=9 August 2018 |archive-url=https://web.archive.org/web/20180809184337/https://www.avisen.dk/overblik-transkoennedes-kamp-mod-lovgivningen_499227.aspx |archive-date=9 August 2018}} Japan currently requires transgender people to be sterilized and have their ovaries removed to be recognized as a different gender.{{Cite news |date=2019-03-14 |title=Japan says transgender people must be sterilised |newspaper=The Economist |url=https://www.economist.com/asia/2019/03/14/japan-says-transgender-people-must-be-sterilised |access-date=2022-03-18 |issn=0013-0613}}

{{See also|Informed consent#History}}

The Hippocratic Corpus, an ancient Greek text discussing medical ethics, advises that physicians conceal most information from patients to give the patients the best care.{{cite book |last1=Faden |first1=Ruth R. |url=https://archive.org/details/historytheoryofi0000fade |title=A history and theory of informed consent |last2=Beauchamp |first2=Tom L. |last3=King |first3=Nancy M.P. |publisher=Oxford University Press |year=1986 |isbn=978-0-19-5036862 |edition=Online |location=New York |url-access=registration}}{{rp|61}} The 1767 English case Slater vs Baker and Stapleton found against two doctors who had refractured a patient's leg without consent.{{Cite book |last=Faden |first=Ruth R. |url=https://www.worldcat.org/oclc/228168485 |title=A history and theory of informed consent |date=1986 |publisher=Oxford University Press |others=Tom L. Beauchamp, Nancy M. P. King |isbn=1-4237-6352-1 |location=New York |oclc=228168485}}{{Rp|page=116}} Thomas Percival was a British physician who published a book called Medical Ethics in 1803, which makes no mention of soliciting for the consent of patients or respecting their decisions.{{rp|68}} Percival said that patients have a right to truth, but when the physician could provide better treatment by lying or withholding information, he advised that the physician do as he thought best.{{rp|68}} Benjamin Rush, an 18th-century United States physician, in a lecture entitled "On the duties of patients to their physicians", stated that patients should be strictly obedient to the physician's orders; this was representative of much of his writings.{{cite book |last1=Faden |first1=Ruth R. |url=https://archive.org/details/historytheoryofi0000fade |title=A history and theory of informed consent |last2=Beauchamp |first2=Tom L. |last3=King |first3=Nancy M.P. |publisher=Oxford University Press |year=1986 |isbn=978-0-19-503686-2 |edition=Online |location=New York |url-access=registration}}{{rp|65}}

The US Canterbury v. Spence case established the principle of informed consent in US law. Earlier legal cases had created the underpinnings for informed consent, but his judgment gave a detailed and thought-through discourse on the matter.{{Cite book |url=https://www.worldcat.org/oclc/294067618 |title=Health law and bioethics: cases in context |date=2009 |publisher=Aspen Publishers/Wolters Kluwer |others=Sandra H. Johnson |isbn=978-0-7355-7767-1 |location=New York |chapter=Chapter 1: Canterbury vs Spence |oclc=294067618}} The judgment cites cases going back to 1914 as precedent for informed consent.{{Rp|page=56}}

{{See also|Public health#History}}

In response to the bubonic plague, some city states restricted movement of people into them using cordon sanitaires, and separated those were suspected of being infected into makeshift camps.{{Cite journal |last=Tognotti |first=Eugenia |title=Lessons from the History of Quarantine, from Plague to Influenza A |journal=Emerging Infectious Diseases |year=2013 |volume=19 |issue=2 |pages=254–259 |doi=10.3201/eid1902.120312 |issn=1080-6040 |pmc=3559034 |pmid=23343512}}{{Rp|page=254}} Merchant sailors were made to isolate in lazarettos, hospitals for infectious diseases.{{Rp|page=255}} England created quarantine regulations in 1663 to confine ships suspected of being infected with the plague.{{Rp|page=255}} In response to cholera outbreaks in the 1830s, some European cities people with symptoms were forced into lazarettos.{{Rp|page=256}} An 1853 law in the United Kingdom made vaccination compulsory with those refusing to comply receiving fines.{{Cite journal |vauthors=El Amin AN, Parra MT, Kim-Farley R, Fielding JE |date=June 2012 |title=Ethical Issues Concerning Vaccination Requirements |journal=Public Health Reviews |volume=34 |issue=1 |pages=1–20 |doi=10.1007/BF03391666 |issn=2107-6952 |s2cid=155224076|doi-access=free }} People with symptoms of tuberculosis have been detained in New York from 1902.{{Cite journal |last=Lerner |first=Barron H. |date=1999-01-01 |title=Catching Patients: Tuberculosis and Detention in the 1990s |journal=Chest |language=English |volume=115 |issue=1 |pages=236–241 |doi=10.1378/chest.115.1.236 |issn=0012-3692 |pmid=9925090|doi-access= }}{{Rp|page=237}} During the Spanish flu pandemic western cities implemented social distancing and closed schools, churches, theatres and restricted public gatherings.{{Rp|page=257}} During the COVID-19 pandemic many countries implemented lockdowns restricting movement, enforcing working from home{{Cite journal |last1=Pang |first1=Zhihong |last2=Becerik-Gerber |first2=Burçin |last3=Hoque |first3=Simi |last4=O’Neill |first4=Zheng |last5=Pedrielli |first5=Giulia |last6=Wen |first6=Jin |last7=Wu |first7=Teresa |date=2021-10-26 |title=How Work From Home Has Affected the Occupant's Well-Being in the Residential Built Environment: An International Survey Amid the Covid-19 Pandemic |journal=Journal of Engineering for Sustainable Buildings and Cities |volume=2 |issue=4 |doi=10.1115/1.4052640 |s2cid=244247777 |issn=2642-6641|doi-access=free }} and social distancing.

{{See also|History of mental disorders}}

In 1789, during the French Revolution, the French government issued a directive for the management of the insane. This directive ordered that the insane be incarcerated and treated.{{Cite book |last=Pietikäinen |first=Petteri |url=https://www.worldcat.org/oclc/898113408 |title=Madness: a history |date=2015 |isbn=978-0-415-71316-0 |location=London |oclc=898113408}}{{Rp|page=84}} Bethlem Royal Hospital is a mental hospital in the United Kingdom, which started exclusively treating mental illness in 1377. In 1818, Urban Metcalf, a patient at Bethlam, published a book describing his experience there. He described physical restraint of patients who were attached to walls. This followed a report by the government in 1815 describing conditions in asylums in the UK.{{Rp|page=85}}

{{See also|Political abuse of psychiatry}}

Psychiatric diagnoses have been used for political purposes.{{cite book |author=British Medical Association |url=https://books.google.com/books?id=bMTu_oIfVsIC&pg=PA65 |title=Medicine betrayed: the participation of doctors in human rights abuses |publisher=Zed Books |year=1992 |isbn=978-1-85649-104-4 |pages=65 |author-link=British Medical Association}}{{rp|65}} Psychiatry can be used to bypass standard legal procedures and political incarceration. The use of hospitals instead of jails prevents those detainend from receiving legal aid, makes indefinite incarceration possible, discredits the individuals and their ideas.{{cite book |last1=Veenhoven |first1=Willem |url=https://books.google.com/books?id=RdazE7TGYjgC&pg=PA29 |title=Case studies on human rights and fundamental freedoms: a world survey |last2=Ewing |first2=Winifred |last3=Samenlevingen |first3=Stichting |publisher=Martinus Nijhoff Publishers |year=1975 |isbn=978-90-247-1780-4 |pages=29}}{{rp|29}} During the Nazi era and the Soviet rule religious and political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments".{{cite book |title=Protecting and Promoting Religious Rights in Eastern Europe and the Soviet Union: Hearing Before the Committee on Foreign Relations, United States Senate, Ninety-eighth Congress, Second Session, June 12, 1984 |date=1984 |publisher=United States Congress Senate Committee on Foreign Relations |page=30 |language=en}}{{cite journal |last1=Shah |first1=Ruchita |last2=Basu |first2=Debasish |date=July–September 2010 |title=Coercion in psychiatric care: Global and Indian perspective |journal=Indian Journal of Psychiatry |volume=52 |issue=3 |pages=203–206 |doi=10.4103/0019-5545.70971 |pmc=2990818 |pmid=21180403 |doi-access=free }} From the 1960s to 1986, abuse of psychiatry for political and ideological purposes was reported to be systematic in the Soviet Union, and occasional in Eastern European countries such as Romania, Hungary, Czechoslovakia and Yugoslavia.{{cite book |last1=Stan |first1=Lavinia |title=Transitional Justice in Post-Communist Romania: The Politics of Memory |date=2013 |publisher=Cambridge University Press |isbn=978-1-107-02053-5 |language=en}}{{rp|66}}

Legislation may allow for involuntary of a particular disease or class of diseases such as mental disorders.{{Cite journal |last1=Cronin |first1=T. |last2=Gouda |first2=P. |last3=McDonald |first3=C. |last4=Hallahan |first4=B. |date=2017 |title=A comparison of mental health legislation in five developed countries: a narrative review |journal=Irish Journal of Psychological Medicine |language=en |volume=34 |issue=4 |pages=261–269 |doi=10.1017/ipm.2017.48 |pmid=30115178 |s2cid=52021078 |issn=0790-9667|doi-access=free }}{{Rp|page=263}} Some countries have legislation to involuntarily detain or examine those suspected to have tuberculosis, or treat them if infected.{{Cite journal |last1=Coker |first1=Richard |last2=Thomas |first2=Marianna |last3=Lock |first3=Karen |last4=Martin |first4=Robyn |date=2007 |title=Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law |url=https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/abs/detention-and-the-evolving-threat-of-tuberculosis-evidence-ethics-and-law/254E9359A6FF7BBBCCFEAA7EF3253FE7 |journal=Journal of Law, Medicine & Ethics |language=en |volume=35 |issue=4 |pages=609–615 |doi=10.1111/j.1748-720X.2007.00184.x |pmid=18076512 |s2cid=19924571 |issn=1073-1105|url-access=subscription }}{{Rp|page=610}} Some countries have general legislation allowing for any treatment deemed necessary if an individual is unable to consent to a treatment due to lack of capacity.{{Rp|108}}

Those treated for mental health disorders are committed before involuntary treatment. Those under community treatment orders (also known as outpatient commitment in some countries) may be ordered to take medication, and if they fail to may be committed and treated involuntarily.{{Rp|16}}

In some countries, involuntary treatment for mental health is not used to treat a symptom that is present, but rather to reduce the risk of symptoms returning through the use prophylactic psychotropic medication. This is achieved through the use of outpatient commitment where a patient may be detained in hospital if they fail to take the medication doctors have prescribed them.{{Rp|16}}

File:PinelRestaint.jpg

Chemical restraint, such as forcible injection with the antipsychotic haloperidol or benzodiazepine sedative midazolam, may be used to sedate a patient who is agitated.{{Cite book |url=https://books.google.com/books?id=VuWZDwAAQBAJ |title=Textbook of Adult Emergency Medicine E-Book |vauthors=Cameron P, Little M, Mitra B, Deasy C |date=2019-05-23 |publisher=Elsevier Health Sciences |isbn=978-0-7020-7625-1}}{{Rp|624}}{{Cite book |url=https://books.google.com/books?id=tiCWDwAAQBAJ |title=Psychiatry |vauthors=McKnight R, Geddes J |date=2019-05-15 |publisher=Oxford University Press |isbn=978-0-19-875400-8}}{{Rp|page=152}} In some countries, antipsychotics and sedatives can be forcibly administered to those who are committed, using intramuscular depot injection.{{cite journal | vauthors = Smith JP, Herber OR | title = Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long-acting intramuscular injections: a qualitative study | journal = International Journal of Mental Health Nursing | volume = 24 | issue = 3 | pages = 222–230 | date = June 2015 | pmid = 25394562 | doi = 10.1111/inm.12105 }} Those with anorexia nervosa may receive force-feeding.{{cite journal | vauthors = Túry F, Szalai T, Szumska I | title = Compulsory treatment in eating disorders: Control, provocation, and the coercion paradox | journal = Journal of Clinical Psychology | volume = 75 | issue = 8 | pages = 1444–1454 | date = August 2019 | pmid = 31004507 | doi = 10.1002/jclp.22783 | doi-access = free }}{{Cite web|title=Report to the Czech Governmenton the visit to the Czech Republic carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment|url=https://rm.coe.int/1680695679|page=15}}

Those with infectious diseases such as tuberculosis can be detained and isolated. Brazil,{{cite web |title=Vacinação: quais são as vacinas, para quê servem, por que vacinar, mitos |url=http://www.saude.gov.br/saude-de-a-z/vacinacao/vacine-se |url-status=live |archive-url=https://web.archive.org/web/20191008220137/http://www.saude.gov.br/saude-de-a-z/vacinacao/vacine-se |archive-date=8 October 2019 |access-date=8 October 2019 |website=www.saude.gov.br |language=pt-br}} Bulgaria,{{cite web |title=Vaccine Scheduler {{!}} ECDC |url=https://vaccine-schedule.ecdc.europa.eu/ |url-status=live |archive-url=https://web.archive.org/web/20190902224521/https://vaccine-schedule.ecdc.europa.eu/ |archive-date=2 September 2019 |access-date=8 October 2019 |website=vaccine-schedule.ecdc.europa.eu}} Costa Rica,{{cite web |date=November 15, 2021 |title=Factbox: Countries making COVID-19 vaccines mandatory |url=https://www.reuters.com/business/healthcare-pharmaceuticals/countries-making-covid-19-vaccines-mandatory-2021-08-16/ |url-status=live |archive-url=https://web.archive.org/web/20211118195441/https://www.reuters.com/business/healthcare-pharmaceuticals/countries-making-covid-19-vaccines-mandatory-2021-08-16/ |archive-date=18 November 2021 |access-date=18 November 2021 |website=Reuters}} Croatia, Czechia, France, Hungary, Indonesia,{{cite web |author= |date=6 February 2017 |title=Peraturan Menteri Kesehatan Republik Indonesia Nomor 12 Tahun 2017 Tentang Penyelanggaraan Imunisasi |url=http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._12_ttg_Penyelenggaraan_Imunisasi_.pdf |url-status=live |archive-url=https://web.archive.org/web/20191127022620/http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._12_ttg_Penyelenggaraan_Imunisasi_.pdf |archive-date=27 November 2019 |access-date=4 December 2019 |publisher=Kemenkes |language=id}} Italy, Poland, and Russia{{cite web |date=9 May 2019 |title=Russia: Government Expanding Vaccination for Measles Amid Outbreak in Neighboring Countries {{!}} Global Legal Monitor |url=https://www.loc.gov/law/foreign-news/article/russia-government-expanding-vaccination-for-measles-amid-outbreak-in-neighboring-countries/ |url-status=live |archive-url=https://web.archive.org/web/20200220201409/http://www.loc.gov/law/foreign-news/article/russia-government-expanding-vaccination-for-measles-amid-outbreak-in-neighboring-countries/ |archive-date=20 February 2020 |access-date=6 November 2019 |website=www.loc.gov |vauthors=Grigoryan A}} make certain vaccinations mandatory.

In the Czech Republic, men convicted of sex offenses are in practice given the choice of long-term detention or castration.{{cite journal |vauthors=Lišková K, Bělehradová A |date=July 2019 |title='We Won't Ban Castrating Pervs Despite What Europe Might Think!': Czech Medical Sexology and the Practice of Therapeutic Castration |journal=Medical History |volume=63 |issue=3 |pages=330–351 |doi=10.1017/mdh.2019.30 |pmc=7329228 |pmid=31208483}}{{Rp|page=346}} Japan requires transgender people to undergo sterilization to have their gender formally recognized.{{Cite web |date=2021-05-25 |title=Japan: New Momentum to Reform Transgender Law |url=https://www.hrw.org/news/2021/05/25/japan-new-momentum-reform-transgender-law |access-date=2022-01-04 |website=Human Rights Watch}}{{Cite web |date=2019-03-19 |title=Japan: Compelled Sterilization of Transgender People |url=https://www.hrw.org/news/2019/03/19/japan-compelled-sterilization-transgender-people |access-date=2022-01-04 |website=Human Rights Watch}}

{{See also|Informal coercion}}

File:Cigarettes_in_a_cigarette_packet_(close-up).JPG such as access to cigarettes are used as leverage to encourage patients to accept treatment.]]

Individuals may be forced to undergo mental health treatment which is legally "voluntary" under the threat of involuntary treatment.{{Rp|98}} Many individuals who legally would be viewed as receiving mental health treatment voluntarily believe that they have no choice in the matter.{{efn|name=voluntary-coercion|

"A significant proportion of voluntarily admitted service userscan experience the same level of perceived coercion as that experienced by involuntarily admitted service users. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion, that there is sufficient oversight of the practice to ensure that individual's rights are respected."{{cite journal | vauthors = O'Donoghue B, Roche E, Shannon S, Lyne J, Madigan K, Feeney L | title = Perceived coercion in voluntary hospital admission | journal = Psychiatry Research | volume = 215 | issue = 1 | pages = 120–126 | date = January 2014 | pmid = 24210740 | doi = 10.1016/j.psychres.2013.10.016 | s2cid = 42451989 }}}}

Once voluntarily within a mental health hospital, rules, process, and information asymmetry (the fact that healthcare providers know more about how the hospital functions than a patient) can be used to achieve compliance from a person in voluntary treatment. To prevent someone from leaving voluntarily, staff may use stalling tactics made possible by the fact that all doors are locked. For example, the person may be referred to a member of staff who is rarely on the ward, or made to wait until after lunch or a meeting, behaving as if a person in voluntary treatment does not have the right to leave without permission. When the person is able to talk about leaving, the staff may use vague language to imply that the person is required to stay, relying on the fact that people in voluntary treatment do not understand their legal status.{{efn|name=stalling| See section 6.1 entitled "stalling" in.{{cite journal | vauthors = Sjöström S | title = Invocation of coercion context in compliance communication – power dynamics in psychiatric care | journal = International Journal of Law and Psychiatry | volume = 29 | issue = 1 | pages = 36–47 | date = January 2006 | pmid = 16309742 | doi = 10.1016/j.ijlp.2005.06.001 }} From this section: "[T]he patient's mistaken belief that she cannot leave the hospital facilitates the staff's efforts to stall her. Most importantly, uncertainties regarding formal status make it possible for clinicians to phrase persuasive statements in strategic ways. At times, they might use words that connote coercion where coercion is not formally used. At other times, they might use words of cooperation when formal coercion is in fact applied. Similarly, particular symptoms of the patient, such as a temporary inability to concentrate, might serve as a resource for the staff in managing information in order to accomplish compliance."}}

Szmukler and Appelbaum constructed a hierarchy of types of coercion in mental health care, ranging from persuasion to interpersonal leverage, inducements, threats and compulsory treatment. Here persuasion refers to argument through reason. Forms of coercion that do not use legal compulsion are referred to as informal coercion or leverage.{{Rp|98}} Interpersonal leverage may arise from the desire to please health workers with whom a relationship has formed. Threats may revolve around a health worker helping or hindering the receipt of government benefits.{{cite journal |vauthors=Szmukler G, Appelbaum PS |date=January 2008 |title=Treatment pressures, leverage, coercion, and compulsion in mental health care |journal=Journal of Mental Health |volume=17 |issue=3 |pages=233–244 |doi=10.1080/09638230802052203 |s2cid=144254330}} Studies show that 51%, 35% and 29% of mental health patients have experienced some form of informal coercion in the US, England and Switzerland respectively.{{Rp|100}}

In certain limited circumstance a patient may have capacity but be unable to consent to treatment at a time when a decision is necessary, in such cases surgery may be performed on a patient without consent.{{cite journal | vauthors = Jerjes W, Mahil J, Upile T | title = English law for the surgeon I: consent, capacity and competence | journal = Head & Neck Oncology | volume = 3 | issue = 1 | pages = 41 | date = September 2011 | pmid = 21923926 | pmc = 3184094 | doi = 10.1186/1758-3284-3-41 | doi-access = free }}{{Rp|page=1}} A patient may issue an advance healthcare directive specifying how they would like to be treated if they are unable to consent to treatment. In the UK, a healthcare worker does not need to follow an advanced directive but they will influence decisions.{{Rp|page=5}} Alternatively, a surrogate decision-maker such as a relative, friend or healthcare professional may make decisions on a patient's behalf if a patient is unable to.{{cite journal | vauthors = Shah SG, Farrow A, Robinson I | title = The representation of healthcare end users' perspectives by surrogates in healthcare decisions: a literature review | journal = Scandinavian Journal of Caring Sciences | volume = 23 | issue = 4 | pages = 809–819 | date = December 2009 | pmid = 19740114 | doi = 10.1111/j.1471-6712.2008.00674.x }}{{Rp|page=810}}

{{Main|Covert medication}}

In some instances when a patient refuses the medication suggested by a healthcare professional healthcare workers will cause a patient to take the medication by hiding medication in their food a practice known as covert medication.{{Cite journal |last1=Low |first1=James Alvin |last2=Ho |first2=Esther |title=Managing Ethical Dilemmas in End-Stage Neurodegenerative Diseases |journal=Geriatrics |year=2017 |language=en |volume=2 |issue=1 |pages=7 |doi=10.3390/geriatrics2010008 |issn=2308-3417 |pmc=6371100 |pmid=31011018 |doi-access=free }}

File:Blood_transfusion_B.jpg will choose to die rather than accept blood transfusions.|thumb]]

The faith of Jehovah's Witnesses forbids blood transfusion. Courts in the United States have consistently upheld the right of competent adults to decline blood transfusion even when it would be life-saving, though there have been exceptions where the death of a patient could leave a child orphaned.{{Cite journal | vauthors = McCormick TR |date=September 2008 |title=Ethical Issues Inherent to Jehovah's Witnesses |journal=Perioperative Nursing Clinics |language=en |volume=3 |issue=3 |pages=253–258 |doi=10.1016/j.cpen.2008.04.007}}{{Rp|page=255}}

In the United States, courts have ordered pregnant women to involuntarily undergo caesarean section, intrauterine transfusion, and enforced bed rest.{{Cite journal | vauthors = DeBruin D, Faith Marshall M |date=2021 |title=Coercive Interventions in Pregnancy: Law and Ethics |url=https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1392&context=jhclp |journal=Journal of Health Care Law and Policy}}{{Rp|page=188}} There are cases of clinicians threatening pregnant patients with removal of child custody or withdrawal of care if they decline treatment.{{Rp|page=192}} In the UK, courts are unable to force treatment on pregnant women who are deemed to have capacity, however as of 2016 there were no cases of a still pregnant woman being deemed to have capacity by a court.{{Cite book | vauthors = Halliday S |url=https://www.taylorfrancis.com/books/9781135329938 |title=Autonomy and Pregnancy |date=2016-05-05 |publisher=Routledge |isbn=978-1-135-32993-8 |edition=0 |language=en |doi=10.4324/9781843147206}}{{Rp|page=40}}

{{Clear right}}

{{See also|Pediatric medicine#Pediatric autonomy in healthcare}}

File:A young boy taking after an injection 1.jpg

Parents or medical doctors may make decision about the treatment of children, a principle known as parens patriae.{{cite journal | vauthors = Katz AL, Webb SA | title = Informed Consent in Decision-Making in Pediatric Practice | journal = Pediatrics | volume = 138 | issue = 2 | pages = e20161485 | date = August 2016 | pmid = 27456510 | doi = 10.1542/peds.2016-1485 | s2cid = 7951515 | doi-access = free }}{{Rp|page=5}} In the United States, doctors are responsible for providing a good standard of care for patients who are children which can lead them to make decisions at odds with the parents wishes. Parents have less autonomy to make decisions about their children's care than adult patients have over their own care.{{Rp|page=5}} Treatment may take place even if a child or adolescent disagree with treatment, though the wishes of a child patient are taken more into account the more burdensome treatment is and the worse the prognosis.{{Rp|page=8}}

If a child does not assent to treatment they may be physically held while a procedure is carried out or anaesthesia is carried out.{{cite journal | vauthors = Bray L, Snodin J, Carter B | title = Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence | journal = Nursing Inquiry | volume = 22 | issue = 2 | pages = 157–167 | date = June 2015 | pmid = 25053126 | doi = 10.1111/nin.12074 | s2cid = 206209823 | url = http://clok.uclan.ac.uk/12759/1/Bray%2C%20Snodin%2C%20Carter%20B%20%282015%29%20Holding%20and%20restraining%20children%20-%20ethical%20consideration%20of%20the%20evidence%20-%20pre-published%20edition.pdf }}{{Rp|page=162}} For some procedures, a child may be distracted to allow for treatment.{{Rp|page=159}}

In Italy, court orders have been used to give children of Jehovah's Witnesses life-saving blood transfusion that were refused by their parents.{{cite journal | vauthors = Conti A, Capasso E, Casella C, Fedeli P, Salzano FA, Policino F, Terracciano L, Delbon P | display-authors = 6 | title = Blood Transfusion in Children: The Refusal of Jehovah's Witness Parents' | journal = Open Medicine | volume = 13 | issue = 1 | pages = 101–104 | date = 2018-04-05 | pmid = 29666843 | pmc = 5900417 | doi = 10.1515/med-2018-0016 }}{{Rp|page=102}}

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There is a lot of variation in the rate of involuntary commitment between countries. A review in Europe in 2004 found a thirty-fold difference in the rate of psychiatric commitment between countries, with the median rate being 74 per hundred thousand people. It is estimated that 38% of people who are involuntarily committed experience another form of compulsion such as seclusion or forced medication.{{cite journal |vauthors=Sashidharan SP, Mezzina R, Puras D |date=December 2019 |title=Reducing coercion in mental healthcare |journal=Epidemiology and Psychiatric Sciences |volume=28 |issue=6 |pages=605–612 |doi=10.1017/S2045796019000350 |pmc=7032511 |pmid=31284895}}{{Rp|page=2}}

A 2014 Cochrane systematic review found that compulsory outpatient treatment of those with severe mental health disorders "results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care."{{cite journal | vauthors = Kisely SR, Campbell LA, O'Reilly R | title = Compulsory community and involuntary outpatient treatment for people with severe mental disorders | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 6 | pages = CD004408 | date = March 2017 | pmid = 28303578 | pmc = 6464695 | doi = 10.1002/14651858.CD004408.pub5 }} A 2006 review found that as many as 48% of respondents did not agree with their treatment, though a majority of people retrospectively agreed that involuntary medication had been in their best interest.{{cite journal | vauthors = Katsakou C, Priebe S | title = Outcomes of involuntary hospital admission--a review | journal = Acta Psychiatrica Scandinavica | volume = 114 | issue = 4 | pages = 232–241 | date = October 2006 | pmid = 16968360 | doi = 10.1111/j.1600-0447.2006.00823.x | s2cid = 20677644 | doi-access = free }}

A review in 2011 looked at people's experience of coercion in mental health care. It found common themes of feeling violated, disrespected, and not being heard, commonly conceptualized as being dehumanized through isolation. A minority of narratives from people who had been treated involuntarily talked about the necessity of treatment in retrospect.{{efn| See table 1 of:{{cite journal | vauthors = Newton-Howes G, Mullen R | title = Coercion in psychiatric care: systematic review of correlates and themes | journal = Psychiatric Services | volume = 62 | issue = 5 | pages = 465–470 | date = May 2011 | pmid = 21532070 | doi = 10.1176/ps.62.5.pss6205_0465 }} "The aspects of care leading to the experience of coercion were broad, but all involved the forcing of "treatment" onto patients against their will. The themes from these articles highlight feelings of violation, disrespect, and not being heard by their clinicians. The most common conceptualization was that of being dehumanized through a loss of normal human interaction and isolation. Using a wide range of thematic analyses, we found that these themes emerged in each article for a range of treatment interventions; this finding was robust. Positive themes were mentioned in three of the five articles from a minority of patients. These tended to emerge in retrospect, well after a patient's hospitalization, and focused on the need or rationale for treatment. These positive themes tended to reflect the social norms and explanations for compulsory care's leading to coercion, rather than the emotive or subjective responses elicited by such care." }} Studies suggest that coercion in mental health care has a long-lasting psychological effect on individuals leading to reduced engagement and poorer social outcomes, but that this may be reduced by clinicians' knowledge of the effects of coercion.{{Cite book| vauthors = Molodynski A, Rugkåsa J, Burns T |url=https://books.google.com/books?id=O359DAAAQBAJ&q=jorun+coercion&pg=PA296|title=Coercion in Community Mental Health Care: International Perspectives|date=2016|publisher=Oxford University Press|isbn=978-0-19-878806-5|pages=289}}

In medical ethics, involuntary treatment is conceptualized as a form of parens patriae whereby the state takes on the responsibilities of incompetent adults on the basis of the duty to protect and the duty of beneficence (the duty of the state to repair the random harms of nature). The duty to protect is reflected in utilitarianism and communitarianism philosophy, though psychiatrist Paul Chodoff asserted a responsibility to "chasten" this responsibility in light of the political abuse of psychiatry in the Soviet Union.{{Cite book| vauthors = Robertson M, Walter G |url=https://books.google.com/books?id=Hk3OBQAAQBAJ|title=Ethics and Mental Health: The Patient, Profession and Community|date=2013-09-26|publisher=CRC Press|isbn=978-1-4441-6865-5}}{{Rp|82}} This duty to protect has been criticized on the grounds that psychiatrists are not effective at predicting violence, and tend to overestimate the risk.{{Rp|89}}

The obligatory dangerousness criterion is a principle that has been applied to some mental health law that holds that parens patriae should only be applied if an individual is a danger to themselves or others.{{cite journal | vauthors = Appelbaum PS | title = Almost a revolution: an international perspective on the law of involuntary commitment | journal = The Journal of the American Academy of Psychiatry and the Law | volume = 25 | issue = 2 | pages = 135–147 | date = 1997 | pmid = 9213286 | url = https://pubmed.ncbi.nlm.nih.gov/9213286/ }}

Paul Ricœur distinguishes two forms of self, the idem, a short term experience of the self, and the ipse, a longer term persistent experience of the self. In mental illness, the autonomy of the ipse can be undermined by the autonomy of the idem, so involuntary mental health treatment can trade one form of autonomy for another.{{Rp|90}}

Medical sociology seeks to understand the social processes underlying decisions made in medicine.

Sociologist Jeremy Dixon, speaking in the context of the United Kingdom, argues that assessment and monitoring of risk is a core part of mental health practice{{Cite book| vauthors = Chamberlain JM |url=https://books.google.com/books?id=Hnn4CgAAQBAJ&q=medicine+risk+discourse+and+power|title=Medicine, Risk, Discourse and Power|date=2015-11-19|publisher=Routledge|isbn=978-1-317-33196-4}}{{Rp|126}} but that this risk is often in conflict with broadly-defined goals of recovery including living a satisfying life.{{Rp|129}} He argues that this focus on risk causes mental health professionals to make decisions defensively based on reputational damage if there were to be any inquiry and that multidisciplinary approaches are used for this purpose.{{Rp|134}} He cites research showing how mental health professionals may seek to shift the burden of responsibility onto individuals themselves (noting different clinical decisions for those with personality disorders compared to those with psychotic disorders because they are viewed as more responsible for their behaviours), or shift responsibility onto other public health services.{{Rp|134}} Risk assessments themselves are rarely shared with patients.{{Rp|135}}

File:Protest graffiti against TSO Torino.jpg; TSO = MORTE means Involuntary treatment = Death]]

Supporters of involuntary treatment include organizations such as the National Alliance on Mental Illness (NAMI), the American Psychiatric Association, and the Treatment Advocacy Center.{{Cite journal| vauthors = Shdaimah C, O'Reilly N |title=Understanding US debates surrounding standards in involuntary inpatient psychiatric commitment through the Maryland experience|journal=Social Work in Mental Health}}{{Citation needed|date=March 2019}}

A number of civil and human rights activists, anti-psychiatry groups, medical and academic organizations, researchers, and members of the psychiatric survivors movement vigorously oppose involuntary treatment on human rights grounds or on grounds of effectiveness and medical appropriateness, particularly with respect to involuntary administration of mind altering substances, ECT, and psychosurgery. Some criticism has been made regarding cost, as well as of conflicts of interest with the pharmaceutical industry.{{Citation needed|date=March 2019}} Critics, such as the New York Civil Liberties Union, have denounced the strong racial and socioeconomic biases in forced treatment orders.{{cite web | work = New York Lawyers for the Public Interest, Inc. | title = Implementation of Kendra's Law is Severely Biased | date = 7 April 2005 | url = http://nylpi.org/pub/Kendras_Law_04-07-05.pdf | archive-url = https://web.archive.org/web/20070628052901/http://nylpi.org/pub/Kendras_Law_04-07-05.pdf | archive-date=28 June 2007 }}

Special rapporteurs of the United Nations (Catalina Devandas Aguilar and Dainius Puras{{Cite web |title= Isolement et contention en psychiatrie générale: Méthode Recommandations pour la pratique clinique |trans-title=Isolation and restraint in general psychiatry: Method Recommendations for clinical practice |work=Haute Autorité de Santé [High Authority of Health] |url=https://www.has-sante.fr/upload/docs/application/pdf/2017-03/isolement_et_contention_en_psychiatrie_generale_-_argumentaire_2_2017-03-15_10-33-36_53.pdf |date=February 2017 |accessdate=2025-02-26}}) consider it as an infringement of the dignity of those subjected to it, with severe consequences for their physical and mental integrity and call on concerned states to put an end to respect individual's autonomy.

File:André Franquin poster for Amnesty International.png's poster for Amnesty International (1978)|left]]

Involuntary treatment is compared to torture on at least two special reports of the UN, one noting "forced psychiatric interventions, when committed against persons with psychosocial disabilities, satisfies both intent and purpose required under the article 1 of the Convention against Torture, notwithstanding claims of 'good intentions' by medical professionals." However, jurisdiction of some countries (e.g. France) requires intended harm (see: punitive psychiatry) to classify it as such and would classify involuntary treatment, rather as a degrading treatment, if recognize as it.

Amnesty International and Human Rights Watch oppose involuntary treatment.

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{{Globalize section|the Western world|date=July 2020}}

Mentally competent patients have a general right to refuse medical treatment.{{cite journal | vauthors = | title = The right to refuse treatment: a model act | journal = American Journal of Public Health | volume = 73 | issue = 8 | pages = 918–921 | date = August 1983 | pmid = 6869647 | pmc = 1651109 | doi = 10.2105/AJPH.73.8.918 }}{{cite journal| vauthors = Kanaboshi N |date=1 July 2006|title=Competent Persons' Constitutional Right to Refuse Medical Treatment in the U.S. and Japan: Application to Japanese Law |url= https://elibrary.law.psu.edu/psilr/vol25/iss1/3/|journal=Penn State International Law Review|volume=25|issue=1|pages=5}}{{cite web |url=https://www.law.cornell.edu/supct/html/88-1503.ZO.html |title=Cruzan v. Director, Missouri Department of Health, (88-1503), 497 U.S. 261 (1990) |website=www.law.cornell.edu}}

All states in the U.S. allow for some form of involuntary treatment for mental illness or erratic behavior for short periods of time under emergency conditions, although criteria vary. Further involuntary treatment outside clear and pressing emergencies where there is asserted to be a threat to public safety usually requires a court order, and all states currently have some process in place to allow this. Since the late 1990s, a growing number of states have adopted Assisted Outpatient Commitment (AOC) laws.{{cite journal | vauthors = Perlin ML | title = Therapeutic jurisprudence and outpatient commitment law: Kendra's Law and case study | journal = Psychology, Public Policy, and Law | volume = 9 | issue = 1–2 | pages = 183–208 | year = 2003 | pmid = 16700141 | doi = 10.1037/1076-8971.9.1-2.183 | url = https://digitalcommons.nyls.edu/cgi/viewcontent.cgi?article=1771&context=fac_articles_chapters | url-access = subscription }}

Under assisted outpatient commitment, people committed involuntarily can live outside the psychiatric hospital, sometimes under strict conditions including reporting to mandatory psychiatric appointments, taking psychiatric drugs in the presence of a nursing team, and testing medication blood levels. Forty-five states presently allow for outpatient commitment.{{Cite web|title=Browse by State|url=http://www.treatmentadvocacycenter.org/get-help/know-the-laws-in-your-state|access-date=22 June 2016|archive-date=11 December 2015|archive-url=https://web.archive.org/web/20151211183250/http://www.treatmentadvocacycenter.org/get-help/know-the-laws-in-your-state|url-status=dead}}

In 1975, the U.S. Supreme Court ruled in O'Connor v. Donaldson that involuntary hospitalization and/or treatment violates an individual's civil rights. The individual must be exhibiting behavior that is a danger to themselves or others and a court order must be received for more than a short (e.g. 72-hour) detention. The treatment must take place in the least restrictive setting possible. This ruling has since been watered down through jurisprudence in some respects and strengthened in other respects. Long term "warehousing", through de-institutionalization, declined in the following years, though the number of people receiving involuntary treatment has increased more recently.{{When|date=August 2020}} The statutes vary somewhat from state to state.

In 1979, the United States Court of Appeals for the First Circuit established in Rogers v. Okin that a competent person committed to a psychiatric hospital has the right to refuse treatment in non-emergency situations. The case of Rennie v. Klein established that an involuntarily committed individual has a constitutional right to refuse psychotropic medication without a court order. Rogers v. Okin established the person's right to make treatment decisions so long as they are still presumed competent.

Additional U.S. Supreme Court decisions have added more restraints, and some expansions or effective sanctioning, to involuntary commitment and treatment. Foucha v. Louisiana established the unconstitutionality of the continued commitment of an insanity acquittee who was not suffering from a mental illness. In Jackson v. Indiana the court ruled that a person adjudicated incompetent could not be indefinitely committed. In Perry v. Louisiana the court struck down the forcible medication of a prisoner for the purposes of rendering him competent to be executed. In Riggins v. Nevada the court ruled that a defendant had the right to refuse psychiatric medication while he was on trial, given to mitigate his psychiatric symptoms. Sell v. United States imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the sole purpose of making them competent and able to be tried. In Washington v. Harper the Supreme Court upheld the involuntary medication of correctional facility inmates only under certain conditions as determined by established policy and procedures.{{cite web|title=Washington et al., Petitioners v. Walter Harper|url=http://www.druglibrary.org/schaffer/legal/l1990/Harper.htm|access-date=10 October 2007}}

• Coerced abstinence
• Political abuse of psychiatry (also known as "political psychiatry" and as "punitive psychiatry")
• Social control
• Specific jurisdictions' provisions for a temporary detention order for the purpose of mental-health evaluation and possible further voluntary or involuntary commitment:

:* United States:

::* California: 5150 (involuntary psychiatric hold) and Laura's Law (providing for court-ordered outpatient treatment)

:::* Lanterman–Petris–Short Act, codifying the conditions for and of involuntary commitment in California

::* Florida: Baker Act and Marchman Act

• Giorgio Antonucci (elimination)
• Thomas Szasz (elimination)
• Robert Whitaker (reduction)
• E. Fuller Torrey (expansion)
• DJ Jaffe (expansion)

• Mental Health America (reduction/modification)
• Mad in America (reduction/elimination)
• PsychRights (reduction/elimination)
• Anti-psychiatry, also known as the "anti-psychiatric movement" (reduction/elimination)
• Citizens Commission on Human Rights (reduction/elimination; founded as a joint effort of the anti-psychiatric Church of Scientology and libertarian mental-health-rights advocate Thomas Szasz)
• MindFreedom International (reduction/elimination)
• Treatment Advocacy Center (expansion)
• NAMI (expansion)

{{notelist}}

{{reflist}}

• [https://www.mhselfhelp.org/ National Mental Health Consumers' Self-Help Clearinghouse]

{{Anti-psychiatry}}

{{Substantive human rights}}{{Mental health law}}

{{Medical harm}}

Category:Anti-psychiatry

Category:Human rights abuses

Category:Ethics in psychiatry

Category:Mental health law