Rogers v. Okin
Encyclopedia
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit
considered whether a mental patient, committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency conditions.
suit filed in 1975 by patients at Boston State Hospital challenging the hospital's restraint, seclusion and involuntary treatment
policies in Federal District Court. Seven plaintiffs were named. The law suit sought to enjoin the hospital from medicating patients against their will and from isolating them in seclusion cells. Greater Boston Legal Services represented the patients.
The district court held that the competency
of committed patients is assumed until a patient is adjudicated incompetent, holding that forced medication was an invasion of privacy
and an affront to human dignity as such patients are capable of making non-emergency treatment decisions. Only under emergency conditions could such a patient be forcibly medicated where there was a substantial likelihood of physical harm to the patient's self or others. Voluntary patients had the same rights.
The case was appealed to the US Court of Appeals for the First Circuit which affirmed the lower courts ruling that patients had the right to decide for themselves whether to accept treatment of antipsychotic drugs and that mental illness did not render a person incompetent. However, the court rejected the lower court's standard for determining when medications could be given involuntarily, determining that the evaluating physician was to made ultimate medication decision. The court disagreed with the trial judge that forcible medication, absent an emergency, could be administered only after an adjudication of incompetence. It also rejected the trial court's holding that voluntary patients could refuse medication, stating that a voluntary patient who wished to refuse treatment should leave the hospital.
The state appealed on a writ
of certiorari
the US Supreme Court for review The Supreme Court granted certiorari but then remanded the case back to the Court of Appeals in the light of Richard Roe
. The American Psychological Association
submitted a brief supporting the plaintiffs to the Supreme Judicial Court of Massachusetts.
This decision was one of the first that contributed to a growing body of case law recognizing that prisoners and competent mental patients have the right to refuse treatment
. Rogers v. Okin set forth a procedure that would copied by many other states. This procedure requires a court hearing before a patient may be involuntarily medicated.
United States Court of Appeals for the First Circuit
The United States Court of Appeals for the First Circuit is a federal court with appellate jurisdiction over the district courts in the following districts:* District of Maine* District of Massachusetts...
considered whether a mental patient, committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency conditions.
Circumstances
This case began as a federal class actionClass action
In law, a class action, a class suit, or a representative action is a form of lawsuit in which a large group of people collectively bring a claim to court and/or in which a class of defendants is being sued...
suit filed in 1975 by patients at Boston State Hospital challenging the hospital's restraint, seclusion and involuntary treatment
Involuntary treatment
Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
policies in Federal District Court. Seven plaintiffs were named. The law suit sought to enjoin the hospital from medicating patients against their will and from isolating them in seclusion cells. Greater Boston Legal Services represented the patients.
The district court held that the competency
Competence (law)
In American law, competence concerns the mental capacity of an individual to participate in legal proceedings. Defendants that do not possess sufficient "competence" are usually excluded from criminal prosecution, while witnesses found not to possess requisite competence cannot testify...
of committed patients is assumed until a patient is adjudicated incompetent, holding that forced medication was an invasion of privacy
Invasion of privacy
United States privacy law embodies several different legal concepts. One is the invasion of privacy, a tort based in common law allowing an aggrieved party to bring a lawsuit against an individual who unlawfully intrudes into his or her private affairs, discloses his or her private information,...
and an affront to human dignity as such patients are capable of making non-emergency treatment decisions. Only under emergency conditions could such a patient be forcibly medicated where there was a substantial likelihood of physical harm to the patient's self or others. Voluntary patients had the same rights.
The case was appealed to the US Court of Appeals for the First Circuit which affirmed the lower courts ruling that patients had the right to decide for themselves whether to accept treatment of antipsychotic drugs and that mental illness did not render a person incompetent. However, the court rejected the lower court's standard for determining when medications could be given involuntarily, determining that the evaluating physician was to made ultimate medication decision. The court disagreed with the trial judge that forcible medication, absent an emergency, could be administered only after an adjudication of incompetence. It also rejected the trial court's holding that voluntary patients could refuse medication, stating that a voluntary patient who wished to refuse treatment should leave the hospital.
The state appealed on a writ
Writ
In common law, a writ is a formal written order issued by a body with administrative or judicial jurisdiction; in modern usage, this body is generally a court...
of certiorari
Certiorari
Certiorari is a type of writ seeking judicial review, recognized in U.S., Roman, English, Philippine, and other law. Certiorari is the present passive infinitive of the Latin certiorare...
the US Supreme Court for review The Supreme Court granted certiorari but then remanded the case back to the Court of Appeals in the light of Richard Roe
John Doe
The name "John Doe" is used as a placeholder name in a legal action, case or discussion for a male party, whose true identity is unknown or must be withheld for legal reasons. The name is also used to refer to a male corpse or hospital patient whose identity is unknown...
. The American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
submitted a brief supporting the plaintiffs to the Supreme Judicial Court of Massachusetts.
Decision
The Massachusetts Supreme Judicial Court decision was consistent with its ruling in Richard Roe. The decision required that a court must hold a full evidentiary hearing, with counsel representing both sides and expert witness if needed, to make the decision whether an incompetent patient should be treated. This determination was to be made on the basis of "substituted judgment", that is, on an estimation of what the patient would have desired, were he competent.Significance
Throughout most of the 1970s, the legal assumption was that, once hospitalized, a patient had no role in treatment decisions. Hospitals could medicate and use other means of control or treatment without consultation with the patient or the patient's family.This decision was one of the first that contributed to a growing body of case law recognizing that prisoners and competent mental patients have the right to refuse treatment
Involuntary treatment
Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
. Rogers v. Okin set forth a procedure that would copied by many other states. This procedure requires a court hearing before a patient may be involuntarily medicated.