Penn Ethicist Proposes New Category for Psychiatric Patients to Justify Instances of Compulsory Treatment

The “involuntary treatment” of unwilling psychiatric patients has long been accepted as necessary in some cases, for the sake of patients and society, though it can raise serious ethical concerns as well as legal barriers. In a Viewpoint essay published online today in  JAMA, Dominic Sisti, PhD, an assistant professor of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania, argues that some of the concerns about treating patients without their consent would be alleviated if the mental health profession recognized an important distinction among these cases.

“The current strict limitations on involuntary treatment risk allowing people with psychiatric illness to go untreated and experience worsening symptoms despite compelling evidence that they would want to be well,” said Sisti, who is also the director of the director of Penn’s Scattergood Program for Applied Ethics in Behavioral Health Care, and an assistant professor of Psychiatry at Penn. “A patient may have previously expressed a wish to be treated while in crisis — in which case, a treatment framed as involuntary is actually something else. The proposed concept of nonvoluntary treatment provides a more precise categorization of such cases.”