Rejecting the Logic of Confinement: Care Relationships and the Mentally Disabled under Tort Law
Light, Sarah, The Yale Law Journal
"A psychiatrist of long and fruitful experience once remarked that the chief difference between the normal man and the one who was mentally sick, was that the latter was inside the walls of a hospital and the former was not."(1)
Contemporary tort law articulates a norm in favor of confinement for the mentally disabled.(2) It encourages their institutionalization and discourages their reintegration into the community.(3) This Note argues that a rationale for holding mentally disabled individuals liable for their torts that relies upon a preference for confinement is misplaced, because it creates an incentive to confine a mentally disabled individual even when this might not be in the individual's best interest. Regardless of economic incentives, however, reliance upon a confinement rationale reflects an outmoded understanding of the proper place of the mentally disabled in contemporary American society. This rationale should be reconsidered by courts, commentators, and advocates. American civil rights law has shifted radically in its treatment of the mentally disabled since the early part of this century, while tort law has stagnated in this regard. This Note argues that when considering the negligence liability of the mentally disabled, courts should not focus upon "geography"--that is, upon whether a defendant is confined. Rather, courts should focus solely upon the nature of the relationship between the parties, their knowledge and expectations, and their relative abilities to prevent harm.(4)
This Note is divided into five Parts. Part I discusses how tort law has traditionally held mentally disabled people to an objective "reasonable person" standard for the torts they commit within the community.(5) One reason courts have given for imposing this liability is that it provides an incentive for family members to confine their mentally disabled relatives, in order to prevent harm to innocent strangers and to society as a whole.(6) Part II demonstrates that in the only four reported tort cases before 1991 to address the mentally disabled in care relationships, courts failed to recognize the importance of this unique relationship. This Part examines why courts continued to hold mentally disabled persons liable for their torts, even against a caregiver, and even when family members had taken steps to obtain care for their mentally disabled relatives, either by placing them in institutions or by hiring nurses to provide at-home care.(7) Coupled with the small number of cases involving institutionalized defendants before 1991, this fact may have led commentators to downplay the importance of the logic of confinement as a rationale for imposing liability.
In a line of cases arising since 1991, however, the confinement rationale has become increasingly important. Part III addresses a line of cases creating a new exception to the duty owed by the mentally disabled. In these cases, a caregiver has sued a mentally disabled defendant under his or her care for negligent or intentional torts. In these cases, courts have carved out a new exception to the general rule imposing liability upon the mentally disabled.(8) Courts have uniformly held that a mentally incompetent defendant living in an institution owes no duty of care to a paid caregiver because imposing liability would provide no further incentives to confine the defendant. Some of these decisions have drawn the exception narrowly, so that future courts might apply it only in cases in which defendants reside in institutions. This focus on the logic of confinement, coupled with fact patterns involving institutionalized defendants, rather than mentally disabled defendants in home-care settings, reinforces the notion that the mentally disabled should properly reside within institutions.
Part IV argues that the no-duty rule adopted in these post-1991 cases is correct, but not because of the logic of confinement. A rule that focuses on the care relationship, rather than on the defendant's geography, would encourage a mentally disabled person to seek appropriate professional care, rather than confinement that may not be appropriate. …