Vermont Law Review
When determining if involuntary treatment is appropriate, the proper question for courts to ask is not whether autonomy is preferable to involuntary treatment, but whether no treatment at all is preferable to involuntary treatment. When legislatures develop and courts apply statutes governing civil commitment, the interests at stake should be considered not at the abstract level of "freedom" or "autonomy," but rather at the concrete level of the consequences that are likely to result from providing or not providing involuntary treatment. Only by examining the particular interests that are likely to be affected can informed decisions be made about when involuntary treatment is appropriate.
Involuntary Treatment of the Mentally Ill: Autonomy is Asking the Wrong QuestionIf courts were to ask whether, for someone who is mentally ill, the overall benefits of providing involuntary treatment would be greater than the overall benefits of not providing any treatment at all, the result might not be that any more people, or any fewer, would be committed to involuntary treatment. The advantage of this approach, then, would not be the number of people who were committed but the reason that anyone was committed. If courts considered the specific consequences of allowing, as well as not allowing, the choice to refuse treatment, then commitment decisions could be based on the concrete realities of living with an untreated mental illness as well as the concrete realities of living with involuntary treatment. These issues would become somewhat less problematic if the concern of courts was to maximize the overall well-being of those who are mentally ill, rather than to maximize only their autonomy.
Dora W. Klein, Involuntary Treatment of the Mentally Ill: Autonomy is Asking the Wrong Question, 27 Vt. L. Rev. 649 (2003).