Academic journal article Law and Psychology Review

One Nation under Boyd: Reconciling the Right to Refuse Mental Health Treatment with Religious Belief versus Delusion

Academic journal article Law and Psychology Review

One Nation under Boyd: Reconciling the Right to Refuse Mental Health Treatment with Religious Belief versus Delusion

Article excerpt

TABLE OF CONTENTS  INTRODUCTION  I.     BACKGROUND: SETTING THE STAGE FOR IN RE BOYD            A. The Establishment Clause and the Free Exercise Clause                      1. The Supreme Court's Attempt to Define Religion            B. The Right to Refuse Treatment in Mental Health Patients            C. Belief vs. Delusion  II.    THE BOYD TEST: A MENTAL HEALTH PATIENT'S TREATMENT REFUSAL          FOR RELIGION             A. The Religious Belief as "a recognizable, established one"            B. The Religious Belief as Demonstrable Through Patient               Action            C. The Religious Belief as "long held" or the Result of "a               religious conversion"  III.   SINCERE ADHERENCE? ADVANCE DIRECTIVES PREVENTING ABUSE          RELIGION IN BOYD  IV.    CONCLUSION 

INTRODUCTION

A mental health patient's right to refuse treatment is an intriguing aspect of American jurisprudence. Advances in scientific and societal understanding of mental health have changed the methods of treatment in this area significantly in recent decades. (1) However, there is another element of mental health treatment that remains essential to each person, regardless of treatment type: choice. (2) This deeply-held freedom establishes itself in the form of the right to refuse treatment in mental health patients, even if the treatment is otherwise deemed beneficial. (3)

The added consideration of refusal based on religious grounds implicates further legal complexity in the realm of mental health law and treatment refusal. (4) Distinct from religious liberty claims in other areas, those involved in the right to refuse treatment are unique among mental health patients because they raise a certain question: is this objection the product of a religious belief or a religious delusion? (5) Mental health professionals must draw this distinction correctly because of the vastly different paths which mental health patients can take within the system, depending upon the diagnosis. (6) Diagnosis of a delusion, at the very least, will likely result in a form of mental health treatment. (7) While courts have rarely taken the delusion versus belief question into consideration, the District of Columbia Court of Appeals, in In re Boyd, devised a substituted judgment test for a mental health patient who raised religious objections to psychotropic treatment. (8) This test seems to give the patient the ability to exercise her religious beliefs, (9) yet the implications that stem from its application may prove otherwise.

The Boyd test focuses on the recognized nature of the belief and the action demonstrating that belief, (10) but this focus may lead to results that go against the Supreme Court's decisions on religion and the right of mental health patients to refuse treatment. This paper suggests an alternative to the substituted judgment test in Boyd and seeks to allow treatment of mental health patients in the context of religious objection. Specifically, the Boyd test should be modified so as not to offend the principles of religious liberty under the First Amendment and interpreted by the Supreme Court by eradicating the first Boyd factor, which favors established religions over others, and adopting a more limited second factor, which relies on patient action to demonstrate religious belief.

While there are many methods and medications in the mental health field that fall under the umbrella of treatment, this paper seeks only to address a form of treatment known as psychotropic medication. Psychotropic medication is at issue in Washington v. Harper, In re Boyd, and in many other cases concerning the right of mental health patients to refuse treatment. (11) Part I includes a discussion of the First Amendment, the Supreme Court's interpretation of it, the mental health patient's right to refuse treatment, and the distinction between a religious belief and a delusion. Part II contains the three components of the test formulated in Boyd and an argument for the test to be partially eradicated, partially modified, and partially unaltered to accord with both the Supreme Court's interpretation of the First Amendment and the right of mental health patients to refuse treatment. …

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