Center for Biomedical Ethics

ETHICS INSTRUCTION IN THE THIRD YEAR CLERKSHIPS


PSYCHIATRY CLERKSHIP ETHICS SESSIONS (one session per six weeks)

Barry W. Wall, MD
Clinical Associate Professor
Dept. of Psychiatry & Human Behavior
Tel: (401) 273-1010 or (401) 462-1572

TOPIC: Forced (involuntary) treatment


OBJECTIVES: At the end of this session, the student will:

    1. Be aware of situations in which a patient may be legally required to undergo treatment
    2. Be able to elucidate the ethical issues involved in involuntary treatment in psychiatric (as well as other medical) settings

RESOURCES: Please read the following articles prior to the session:

CLINICAL ROADMAP: (to be discussed at session)

What you seek:

The legal standard: Type: Who can ask for it:

Acute involuntary
hospitalization

DTS (danger to self)
DTO (danger to others)
GD (gravely disabled)

Emergency certification:
immediate; imminent
Lots of people

Non-acute
involuntary hospitalization

DTS
DTO
GD
Civil commitment:
continued unsupervised presence in the community
2 physicians only, and
to be decided by a judge

Involuntary outpatient
treatment

DTS
DTO
GD
COOP (Court-ordered
outpatient treatment )
2 physicians only, and
to be decided by a judge

Forced meds or other form of treatment (e.g. surgery)

competence PFI (Petition for Instruction) 1 physician, and to
be decided by a judge