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Because of the mental disorder…

  • Stephen J. Carey (a1)
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Because of the mental disorder…

  • Stephen J. Carey (a1)
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eLetters

Psychiatric patients in Scotland have the same rights as others to refuse treatment, if capable.

James A. T. Dyer, retired psychiatrist
29 November 2010

Stephen Carey [The Psychiatrist (2010) 34: 497] asks "Was it really the view of the Scottish Parliament that a patient who refuses medication for a severe psychotic exacerbation on grounds not actually caused by thisillness should remain untreated?

Indeed it was, and this was a positive innovation in the Mental Health (Care and Treatment) (Scotland) Act 2003 ("the Act"). It means that psychiatric patients in Scotland now have the same right as other patients to refuse treatment if they are capable of doing so (at least under civil procedure).

The Act is based on certain principles which are stated in it. One of these is "non-discrimination" which is defined, rather clumsily, in section 1 (3)(g) as "the need to ensure that, unless it can be shown that it is justified in the circumstances, the patient ["patient" is defined insection 329 of the Act as "a person who has, or appears to have, a mental disoder"]is not treated in a way that is less favourable than the way in which a person who is not a patient [i.e.does not have a mental disorder] might be treated in a comparable situation".

The inclusion of a test of significant impairment, because of the mental disorder, of decision making ability in relation to treatment - effectively a capacity test - "...provides a specific and ethically justifiable reason for over-ruling a person's autonomy, in that the person's ability to exercise autonomy has already been usurped as a consequence of the mental disorder”1.

Does Dr Carey wish to work in a system where a patient's competent refusal of treatment can be over-ridden simply because he or she has a mental disorder of a particular nature or degree?

Reference1. Scottish Executive (2001): Review of the Mental Health Scotland Act 1984. SE 2001/56. (Report of the Millan Committee)

Declaration of interest:

I was a member of the Millan Committee 1999-2001, the Committee which carried out the Review of the Mental Health Scotland Act 1984 and put forward proposals for new legislation.
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Conflict of interest: None Declared

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