Systematic violations of patients’ rights and safety: forced medication of a cohort of 30 patients in Alaska

Abstract

Background: Psychiatric patients’ human rights are often violated when forced treatment orders are issued. Methods: We assessed the records for 30 consecutive petitions for mental health commitment in which an involuntary medication order was requested, from Anchorage, Alaska. Results: In 29 cases, the commitment petition was granted. The forced medication order was granted in 27 of the 30 cases. In 26 cases, in violation of previous Supreme Court rulings, the patients’ desires, fears, wishes and experiences were ignored even when the patients were afraid that the neuroleptics might kill them or when they had experienced serious harms such as tardive dyskinesia. The ethical and legal imperative of offering a less intrusive treatment was also ignored. Benzodiazepines were not offered. Psychotherapy was not offered or mentioned in 15 cases. The providers claimed, contrary to the evidence, that psychotherapy does not work. Dicussion: The legal procedures can best be characterized as a sham, in which the patients are defenseless. The power imbalance and abuse were extreme, and several of the psychiatrists who argued for forced treatment obtained court orders for administering drugs and dosages that were dangerous. We suggest forced medication be abandoned.