Coercing future freedom: consent and capacities for autonomous choice

J Law Med Ethics. 2010 Winter;38(4):799-806. doi: 10.1111/j.1748-720X.2010.00533.x.


In this paper I examine some of the significant moral concerns inherent in cases of treatment refusal involving patients with psychotic disorders. In particular, I explore the relevance of the principle of autonomy in such situations. After exploring the concept of autonomy and explaining its current and historical significance in a health care setting, I argue that because autonomous choice depends for its existence upon certain human functions such as the ability to reason, judge, and assess consequences, patients cannot be said to be making free and autonomous decisions if these capacities are compromised. I contend further that because psychotic disorders have the potential to compromise these functions in the future, it is appropriate, in some limited cases, to coerce patients with psychotic disorders to undergo treatment in order to preserve their future decision-making capacities and to protect their ability to recognize and respect the autonomy of others.

MeSH terms

  • Adult
  • Coercion*
  • Commitment of Mentally Ill / legislation & jurisprudence
  • Dangerous Behavior
  • Female
  • Humans
  • Informed Consent / ethics*
  • Informed Consent / legislation & jurisprudence
  • Medication Adherence
  • Mental Competency*
  • Personal Autonomy
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy*
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy
  • Treatment Refusal*
  • United States