Mentally ill have too much autonomy for their own good, says professor

  • March 8, 2007
homelessTORONTO - Putting a person in jail for being sick might sound extreme, barbarous and unreasonable, but 40 per cent of the inmates in Canada’s prison systems suffer mental illness. AND Approximately 35 per cent of the homeless suffer serious forms of mental illness. Philosopher and bioethicist Barry Brown argues that society should do more for the mentally ill than tossing them in jail or out on the street.
The problem, according to Brown, is how personal autonomy rules as almost the sole value in the ethics of health care.

In the annual Cardinal Ambrozic Lecture presented by the Canadian Catholic Bioethics Institute March 2, Brown argued that doctors and health care administrators have to find ways to continue treating mentally ill patients who refuse treatment or deny their illness. Laws that allow any adult to refuse treatment so long as they do not present a danger to themselves or others, and they show some understanding of the consequences of refusing treatment, have resulted in the social tragedy of vulnerable people sleeping on subway grates and being arrested for nuisance crimes, Brown said.

Extreme deference to personal autonomy has meant patients who are only marginally competent routinely refuse treatment for manic depression, schizophrenia and dissociative disorders. So long as patients are violent or delusional, the law says they may be treated against their wishes. As soon as the treatment begins to work, patients may refuse treatment and are routinely returned to the street, Brown said.

“The right to refuse treatment when one is marginally competent takes autonomy to an extreme,” said the retired University of Toronto professor of philosophy.

Brown argues patients should be pressured to continue treatment if non-treatment is likely to result in homelessness, run-ins with police or readmission to hospital in the medium- to long-term future.

The health care system has granted mental health patients “an autonomy the exercise of which will lead to the eventual loss of autonomy.”

Brown said he is not advocating the steamrolling of patient rights or return to the mid-20th-century asylum system. And the health care system could avoid a constant crisis of having to determine who really is competent to refuse treatment with earlier intervention and by reducing the stigma which prevents two-thirds of mentally ill people from seeking treatment, he said.

In a Catholic health care setting the legitimate right of personal autonomy should be balanced against the duty to care for one’s own health, said Brown.

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