A study of the right to refuse treatment.

On June 18, 1982, the United States Supreme Court issued its long-awaited opinion in the "right to refuse treatment" case Mills (previously Okin) v. Rogers. I The Su~reme Court stated that the case posed a substantive issue, "a definition of l a] protected constitutional interest, as well as identification ofthe conditions under which competing state interests might outweigh it," and a procedural issue, "the minimum procedures required by the Constitution for determining that the individual's liberty interest actually is outweighed in a particular instance."~ The Court noted that both these issues were heavily affected by state as well as federal law. The federal Constitution defines minimal liberty interests, while a state may go beyond these minimal rights. Because of the heavy involvement of state interests, the Court decided that the issues it identified must be resolved in light of an intervening Massachusetts Supreme Judicial Court decision, Guardianship of Roe. which held that a person has a protected liberty interest in .. 'decid[ing] for himself whether to submit to the serious and potentially harmful medical treatment that is represented by the administration of antipsychotic drugs.' ":1 The Massachusetts Court' 'required ajudicial determination of substituted judgment [as opposed to that of a court-appointed guardian] before drugs could be administered [involuntarily] in a particular instance, except possibly in cases of medical emergency. "4 The Supreme Court believed that Roe III recognizes rights under Massachusetts law "that are broader than those protected directly by the Constitution of the United States. "5 Although Roe applied to an outpatient who had been declared incompetent, the United States Supreme Court thought it may also apply to inpatients. The case Mills v. Rogers was remanded to the Court of Appeals for the First Circuit; the latter Court's decision in the case was vacated. The Supreme Court does not directly articulate the federal Constitutional requirements for protecting the liberty interest of an involuntarily hospitalized mentally ill person. However, it quoted from two prior cases, Addington v . Texas and Parham v. J.R. 6 In Addington. the Court ruled that "clear-and-convincing" rather than "beyond-a-reasonable-doubt" evidence was sufficient to hospitalize a mentally ill person against his will. The Court commented that "because a person 'who is suffering from a debilitating mental illness' is not 'wholly at liberty,' and because the com-