Explicit refusal of treatment by psychiatric patients: Update, survey, outlook

Background: In his or her practice, a psychiatrist must often deal with pat ients who refuse treatment. In 1990, Quebec radically changed this situatio n by introducing a Civil Code provision imposing judicial intervention To t reat an individual deemed unfit to consent, against his or her will. This p aper presents an assessment and survey of patients and attending psychiatri sts who have used this Code provision. Method: Thirty-nine subjects who explicitly refused treatment were brought to court. We asked a subgroup of these patients to be interviewed using the Drug Attitude Inventory (DAT), the Clinical Global Impression (CGI), and 2 questionnaires specifically considering the court experience of patients a nd attending psychiatrists. Results: The results of the survey show that patients remember their experi ence in court as rather uncomfortable. However, the therapeutic alliance re mained unchanged, even after the legal procedure. Physicians agreed that pa tients would not have been clinically well enough to leave the hospital if they had not received the drug regimen resulting from the court decision. T he dissociation between the perceptions of patients and physicians is compa red with that found in previous studies in the United Stares. Conclusion: Even with a limited sample, this study addresses a delicate, di fficult situation that professionals ale increasingly likely to confront It also proposes further research on alternatives to judicial intervention.