An Alaska Supreme Court decision adds a new layer of judicial oversight in
determining whether involuntary treatment of patients with psychiatric illness
is in the patients' best interest.
The court ruled that state constitutional guarantees of liberty and privacy
require an independent judicial determination of an incompetent mental
patient's best interests before authorizing treatment of patients with
"We hold that in future nonemergency cases a court may not permit a
treatment facility to administer psychotropic drugs unless the court makes
findings that comply with all applicable statutory requirements and, in
addition, expressly finds by clear and convincing evidence that the proposed
treatment is in the patient's best interests, and that no less-intrusive
alternative is available," the court ruled in June in the case Faith
Myers v. Alaska Psychiatric Institute.
According to a brief filed by lawyers representing the Alaska Psychiatric
Institute (API), a state psychiatric facility, Faith Myers had been diagnosed
with schizophrenia and had been hospitalized several times, including at
In recent years, Myers became convinced that her medications were causing
her illness, and in 2000 she weaned herself off all medication, according to
the state's brief. In January 2003, after a period of homelessness, she moved
into an apartment.
"Her daughter, who visited several times, was alarmed by the
apartment's condition, including its uncleanliness, garbage, piles of dirt and
pinecones, clothing rather than food in the refrigerator, food left by her
mother to feed wild animals, and items including a pillow, blanket, reading
material, and food left in the dirt-floored, shared crawl-space under the
apartment," according to the brief.
In time, the manager of the apartment requested Myers' family to remove her
from the apartment, and in February 2003 she was involuntarily committed to
API. Because treatment staff at API believed Myers was incapable of giving
informed consent for medication, they filed a petition for court-ordered
administration of medication with their involuntary commitment petition in
late February 2003.
The court held a hearing on the petition on March 5 of that year and
granted API the right to treat Myers involuntarily. The court's medication
order was stayed pending appeal to the Alaska Supreme Court, and Myers was
discharged from API without the medication order having been implemented,
according to the state's brief.
Attorneys from the Law Project for Psychiatric Rights, an Anchorage-based
group opposed to court-ordered psychiatric medication, argued on behalf of
Myers that the court order violated her constitutional rights. The group also
presented evidence, including testimony from two psychiatrists, stating that
antipsychotic medication was not necessarily in the patient's interest.
"By requiring the least-intrusive alternative to forced psychiatric
drugging, this decision has the potential to change the face of current
psychiatric practice, dramatically improving the lives of people who now find
themselves at the wrong end of a hypodermic needle," said Jim Gottstein,
an attorney for the group representing Myers, in a statement following the
"For people who want to try nondrug approaches, the research is very
clear that many will have much better long-term outcomes, including complete
recovery, after being diagnosed with serious mental illness," Gottstein
said. "This decision restores the rights of those people to pursue that
But experts in forensic psychiatry maintain that the ruling adds a new and
burdensome layer of legal oversight of medical decision making.
"Alaska law had previously limited involuntary treatment of committed
patients to persons who were incompetent to make treatment decisions for
themselves," Paul Appelbaum, M.D., chair of APA's Council on Psychiatry
and Law, told Psychiatric News. "This ruling adds the
requirement that, even for this group, it must be a judge and not a physician
who determines that the proposed treatment is in the patient's best interests
and represents the least-intrusive alternative."
Appelbaum said that other states, such as Massachusetts, have adopted a
similar approach in which all treatment decisions—including alterations
in medications and dosages—must have judicial approval.
"However, given that there are states that don't require judicial
determinations of incapacity, much less approval of specific treatment plans,
Alaska's new approach is at the far end of the spectrum of judicial oversight
of involuntary treatment," Appelbaum said. "Perhaps most troubling
was the court's reliance on legal literature summarizing the effects of
antipsychotic medication from the 1970s, apparently without awareness of the
subsequent introduction of a new generation of medications and of the
substantial changes in treatment approaches since then.
"Alaska's patients and clinicians will be spending a great deal more
time in court and less time in treatment," he said. "It is
difficult to believe that judicial process will result in better choice of
Briefs filed by both sides and other related documents are posted at<http://psychrights.org/index.htm>.▪