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Law in Psychiatry: Rivers v. Katz and Psychiatric Advance Directives

Coursework Instructions:

Week 8: Tutorial Questions
Questions:
TQ 8.1: Rivers v. Katz: Does the fact that an individual has been involuntarily committed to a mental institution mean
that he necessarily lacks the capacity to make treatment decisions? What is the “police power” justification for the
compelled administration of psychiatric medications? What is the “parens patriae” justification? Which of these
justifications allows the forced medication of a patient who has the capacity to make medical decisions?
TQ 8.2: In re K.L.: What is Kendra’s Law? Does the law authorize the administration of psychiatric medications over an
individual’s objection? What are the consequences of an individual’s failure to comply with a court order issued pursuant
to Kendra’s Law? Why did the court reject the claim that Kendra’s Law violated the principles articulated in Rivers v.
Katz?
TQ 8.3: Psychiatric Advance Directives: What are psychiatric advance directives (PADs)? Why might someone want
to create a PAD? Under what circumstances can PADs be overridden? What was the holding in Hargrave v. Vermont? If
courts in other jurisdictions follow the Hargrave decision, how will that affect state laws authorizing clinicians to override
PADs?
DQ 8.1: The New York Civil Liberties Union has argued that Kendra's Law (the outpatient commitment statute discussed
in In re K.L.) “violates the fundamental freedoms of competent, non-dangerous persons with psychiatric disabilities who
constitutionally could not be detained involuntarily in psychiatric facilities.” Do you agree?
DQ 8.2: At the top of the last page of the NAMI excerpt, the author suggests that individuals with psychiatric disorders
might include “Ulysses clauses” in an advance directive to indicate “that any statements made refusing treatments during
periods of incapacity should be ignored.” What do you think of the use of psychiatric advance directives in this manner?
If a patient is actively objecting to the administration of psychiatric medications, but previously (while competent) stated
that such objections should be ignored, should the medications be administered? If your answer is that “it depends,”
explain what factors would be relevant to your determination.

Coursework Sample Content Preview:

Law in Psychiatry
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TQ 8.1: Rivers v. Katz
The capacity to make a decision begins with a person’s basic instincts. Even a mentally ill person has the basic instincts of realizing that what is being done to them makes them feel lesser beings. Hence, the fact that an individual has been involuntary committed to psychiatric treatment does not mean that they lack the capacity to make treatment decisions. Anybody can reject treatment from what they have experienced passively or actively in the past. We have seen in the past people who haven’t been related to any mental issue rejecting treatment. These people are a danger to their lives but they do not lack the capacity to make treatment decisions. Moreover, they feel lack of confidence in the treatment they very treatment they are subject.
Police power, the permissible scope of federal or state legislation may affect the rights of an individual only when those rights conflict with the promotion and maintenance of health, safety, morals and at large, the general welfare of citizens. It means that if a person may appear to be a danger to themselves and others, then action may be taken pursuant police powers. In the case of Rivers v. Katz police in accordance to ‘parens patriae’ has the power to carry out their duties in the protection of mentally ill citizens who do not have the capability to pursue their own health care. Paren patriae is the paternal and protective duty that a state or a court holds over and beyond its citizens rights. It includes all other persons deemed as incompetent in essential decision-making scenario and among others, dependent children and orphans.[Rivers v. Katz, 67 N.Y.2d 485, 504 N.Y.S.2d 74, 495 N.E.2d 337 (1986).]
None of these justifications allows the forced medication of patient who has the capacity to make medical decisions. It is by law illegal to force any citizen who is medically fit and capable to make his/her medical decision. ‘Parens Patriae’ justifications only apply under the circumstances that the patient is incompetent in their aspect of medical decisions or lacks the capability to make medical decisions.
TQ 8.2: In re K.L.
The law help promote civil liberties it does not force direct medication amid the patient’s objection. Instead, it orders a group of people who already have past history of arrests, incarcerations and needless hospitalization to accept getting treatment as a condition to be accepted to live in the community. Instead of ordering individuals into a hospital, the law orders that they receive treatment as outpatients therefore making the commitment more human that making patients lose their freedom under hospital roofs. Kendra’s law includes a diverse eligibility criteria and profound consumer protection.[Kendra's Law Overview and Summary of Results : Mental Illness Policy Org. mentalillnesspolicy.Org. (2019). Retrieved 17 December 2021, from https://mentalillnesspolicy.org/kendras-law/kendras-law-overview.html.]
In case a patient refuses to comply with the treatment order even after some serious efforts to ensure compliance have been made, the physician may order a rehospitaliz...
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