Human Rights and the Involuntary Psychiatric Patient: Scientific, Legal and Philosophical Issues in the Scott Starson Case

Abstract

Two options to human right protection for involuntary schizophrenic inpatients refusing treatment are compared: First, forced treatment until improvement in the illness makes commitment unnecessary, thus, emphasizing dispositional freedom; second, allowing treatment refusal even if it means long-term commitment, thus, emphasizing occurrent freedom. Reviews of relevant issues in psychiatry, Canadian legislation, neuroscience and mind-body issues prepare the ground for an analysis of the two approaches in the light of Gewirth's human rights philosophy. Gewirth examines the dilemma of capable agents using their occurrent freedom to limit their dispositional freedom. Appealing to the responsibility of community agents, he suggests a three-step process in which the second step involves a trial period of treatment. The process suggested by Gewirth resembles the first of the two options, and has the advantages of the treatment preventing irreversible deterioration, and the potential for earlier release with its increase in both personal and situational freedom.