The right to refuse treatment is a legal doctrine in which people cannot be compelled to have treatment for their illnesses even if their refusal leads to adverse outcomes. The Supreme Court found that a person could not be compelled into life-saving treatment. This right was further enumerated in Washington v. Glucksberg; “We have also …
The right to refuse treatment is a legal doctrine in which people cannot be compelled to have treatment for their illnesses even if their refusal leads to adverse outcomes. The Supreme Court found that a person could not be compelled into life-saving treatment. This right was further enumerated in Washington v. Glucksberg; “We have also assumed, and strongly suggested, that the Due Process Clause protects the traditional right to refuse unwanted lifesaving medical treatment.”
If a person is not a danger to themselves or others and can live independently, the government shall not force them into a facility against their will. The Supreme Court found this in O'Connor v. Donaldson; “In short, a State cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by himself…” Accordingly, a person in a crisis can only be placed into an involuntary Conservatorship if they are an immediate danger to themselves or others.
The precedents set by Washington and O'Connor place significant limits on what the state can do when its servants encounter a chronically homeless person. The police, fire, and other health services are limited in their actions to mitigate the situation. Unless officers see an unlawful event more significant than a misdemeanor, they can only provide information and minimal aid to these homeless persons. It leads to cases such as this: the police find a person unsheltered in sub-freezing weather. While having a reasonable expectation that the person will die due to exposure, the police cannot prevent that end via an involuntary hold of the person.
We ought to work to expand the state’s ability to protect people whose mental illnesses endanger themselves. Personal autonomy and the right to refuse treatment are important bedrocks of all people's rights, but as with all rights, these are not absolute. It is the case that someone who is suffering from a mental illness that includes the inability to see that disability is not a person whose rights are protecting them. Without returning to the 1960s style of incarceration of the mentally ill, an expansion of conservator policies like that being instituted in California is necessary. When a person is gravely disabled, not only is it reasonable, but it's a moral imperative that the community safeguard that person. We need to expand the concept of only having the state be able to intercede when a person is a danger to themselves or others but also when it's reasonable to perceive that the person is gravely disabled due to their mental illness. We should observe the policy around California’s extension of 5150’s involuntary hold to include the “Gravely Disabled." California is leading the way, and this policy should be extended nationally.
I cannot speak specifically to New York, but, unfortunately, in many states, the danger posed needs to be imminent. This has an oddly paradoxical effect where you can place a person on a hold and then have them released by the time they have a hearing because the jail/hospital has been able to stabilize them.
Similarly, I have had people engaging in some pretty scary behavior, including failed quasi-suicidal attempts, not meet the imminent standard. Finally, police, who are by nature generalists, are often not as good at articulating these incidents in a way that meets the legal standards, and mental health professionals (who are more capable in this regard) often have ethical objections to forced treatment.
The end result is a highly dysfunctional system that does not work well for the community or the people suffering from mental illness.
The courts really have established that you cannot force treatment, period. And you’re right about police being generalists, with a bias towards seeing everything as a crime. So cities are doing interesting things, including Albuquerque, New Mexico. They’ve created a whole new cabinet-level position in which they have alternative response units, often comprised of a social worker and a paramedic, to be the first responders to a person who is behaving erratically. The police are aware and can react quickly if the situation escalates.
It remains the case, though, that they cannot compel a person to go to the local behavioral health hospital. And given the laxity of the loitering laws here in New Mexico, they cannot even compel the person to move from where they are if it's the case that they are not an immediate danger to themselves or others.
The issue revolves around imminent threats; courts have established that a person's autonomy takes precedence unless there's an immediate threat to themselves or others, rather than a possible or even increased risk. This is what California aims to change through its broadened interpretation of grave disability. This term refers to individuals with mental health disorders who cannot meet their essential needs for food, clothing, or shelter. Neely would undoubtedly qualify under this definition. However, it's likely that this amendment to California's temporary commitment laws will face challenges in the courts.
The right to refuse treatment is a legal doctrine in which people cannot be compelled to have treatment for their illnesses even if their refusal leads to adverse outcomes. The Supreme Court found that a person could not be compelled into life-saving treatment. This right was further enumerated in Washington v. Glucksberg; “We have also assumed, and strongly suggested, that the Due Process Clause protects the traditional right to refuse unwanted lifesaving medical treatment.”
If a person is not a danger to themselves or others and can live independently, the government shall not force them into a facility against their will. The Supreme Court found this in O'Connor v. Donaldson; “In short, a State cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by himself…” Accordingly, a person in a crisis can only be placed into an involuntary Conservatorship if they are an immediate danger to themselves or others.
The precedents set by Washington and O'Connor place significant limits on what the state can do when its servants encounter a chronically homeless person. The police, fire, and other health services are limited in their actions to mitigate the situation. Unless officers see an unlawful event more significant than a misdemeanor, they can only provide information and minimal aid to these homeless persons. It leads to cases such as this: the police find a person unsheltered in sub-freezing weather. While having a reasonable expectation that the person will die due to exposure, the police cannot prevent that end via an involuntary hold of the person.
We ought to work to expand the state’s ability to protect people whose mental illnesses endanger themselves. Personal autonomy and the right to refuse treatment are important bedrocks of all people's rights, but as with all rights, these are not absolute. It is the case that someone who is suffering from a mental illness that includes the inability to see that disability is not a person whose rights are protecting them. Without returning to the 1960s style of incarceration of the mentally ill, an expansion of conservator policies like that being instituted in California is necessary. When a person is gravely disabled, not only is it reasonable, but it's a moral imperative that the community safeguard that person. We need to expand the concept of only having the state be able to intercede when a person is a danger to themselves or others but also when it's reasonable to perceive that the person is gravely disabled due to their mental illness. We should observe the policy around California’s extension of 5150’s involuntary hold to include the “Gravely Disabled." California is leading the way, and this policy should be extended nationally.
But Jordan Neely was dangerous to others. He had a record of violence toward strangers.
I cannot speak specifically to New York, but, unfortunately, in many states, the danger posed needs to be imminent. This has an oddly paradoxical effect where you can place a person on a hold and then have them released by the time they have a hearing because the jail/hospital has been able to stabilize them.
Similarly, I have had people engaging in some pretty scary behavior, including failed quasi-suicidal attempts, not meet the imminent standard. Finally, police, who are by nature generalists, are often not as good at articulating these incidents in a way that meets the legal standards, and mental health professionals (who are more capable in this regard) often have ethical objections to forced treatment.
The end result is a highly dysfunctional system that does not work well for the community or the people suffering from mental illness.
The courts really have established that you cannot force treatment, period. And you’re right about police being generalists, with a bias towards seeing everything as a crime. So cities are doing interesting things, including Albuquerque, New Mexico. They’ve created a whole new cabinet-level position in which they have alternative response units, often comprised of a social worker and a paramedic, to be the first responders to a person who is behaving erratically. The police are aware and can react quickly if the situation escalates.
It remains the case, though, that they cannot compel a person to go to the local behavioral health hospital. And given the laxity of the loitering laws here in New Mexico, they cannot even compel the person to move from where they are if it's the case that they are not an immediate danger to themselves or others.
The issue revolves around imminent threats; courts have established that a person's autonomy takes precedence unless there's an immediate threat to themselves or others, rather than a possible or even increased risk. This is what California aims to change through its broadened interpretation of grave disability. This term refers to individuals with mental health disorders who cannot meet their essential needs for food, clothing, or shelter. Neely would undoubtedly qualify under this definition. However, it's likely that this amendment to California's temporary commitment laws will face challenges in the courts.