Rivers v. Katz

Decision Date10 June 1986
Parties, 495 N.E.2d 337, 55 USLW 2015 Mark RIVERS et al., Appellants, v. Stephen KATZ, as Commissioner of the New York State Office of Mental Health, et al., Respondents. In the Matter of Florence GRASSI, Appellant, v. Wendy ACRISH, as Executive Director of the Harlem Valley Psychiatric Center, et al., Respondents.
CourtNew York Court of Appeals Court of Appeals
OPINION OF THE COURT

ALEXANDER, Judge.

We are presented on this appeal with the issue of whether and under what circumstances the State may forcibly administ antipsychotic drugs 1 to a mentally ill patient who has been involuntarily confined to a State facility.

I

When this litigation commenced, appellants Mark Rivers, Florence Zatz and Florence Grassi were patients at the Harlem Valley Psychiatric Center. Each was being retained pursuant to orders of the Dutchess County Court which had found them to be persons "in need of involuntary care and treatment" in that they have a "mental illness for which care and treatment as a patient in a hospital is essential to [their] welfare and [their] judgment is so impaired that [they are] unable to understand the need for such care and treatment" (Mental Hygiene Law § 9.01).

Mark Rivers was involuntarily committed pursuant to Mental Hygiene Law § 9.27 on or about March 20, 1984 and was retained by court order entered on June 13, 1984. Prior to the entry of this order, Rivers refused to be medicated with antipsychotic drugs, and the administrative review procedures prescribed by the regulations of the Commissioner of Mental Health (14 NYCRR 27.8) were implemented. 2 His objectio were overruled and he was thereafter medicated with various antipsychotic drugs, including Prolixin Hydrochloride, Prolixin Decanoate and Mellaril. Florence Zatz was also involuntarily committed pursuant to Mental Hygiene Law § 9.27 and was retained by court order entered on June 25, 1984. On April 20, 1984, shortly after her involuntary admission but prior to the retention order, she refused to be medicated with antipsychotic drugs but her refusal was similarly overruled following administrative review. She was medicated with Navene and Lithium.

Rivers and Zatz thereafter commenced this declaratory judgment action against the Commissioner and officials of the Harlem Valley Psychiatric Center to enjoin the nonconsensual administration of antipsychotic drugs and to obtain a declaration of their common-law and constitutional right to refuse medication. Special Term denied a request for class certification because plaintiffs had failed to show "the benefit of class action status to outweigh the distinct differences that must be addressed in each instance as well as the benefit of stare decisis for guidance in future cases." Upon defendant's motion for summary judgment, the complaint was dismissed. Special Term reasoned that the involuntary retention orders necessarily determined that these patients were so impaired by their mental illness that they were unable to competently make a choice in respect to their treatment.

Florence Grassi was involuntarily committed to Harlem Valley on August 2, 1984 and subsequently retained pursuant to a court order entered on September 24, 1984. She refused treatment with antipsychotic drugs, but was thereafter forcibly medicated with Prolixin Hydrochloride following completion of the administrative review process in which her protest was overruled. She commenced an article 78 proceeding, alleging that the forcible use of antipsychotic medication violated her common-law and constitutional right to determine her own course of treatment. 3 Her application for preliminary injunctive relief was denied after a hearing, and the proceeding was dismissed upon respondents' cross motion for the same reasons expressed by the court in dismissing the Rivers/Zatz complaint.

The Appellate Division consolidated appeals by Rivers, Zatz and Grassi from the respective Special Term order and judgments, and affirmed for reasons stated at Special Term (112 A.D.2d 926, 491 N.Y.S.2d 1011). We now reverse and hold that the due process clause of the New York State Constitution (art. I, § 6) affords involuntarily committed mental patients a fundamental right to refuse antipsychotic medication.

II-A

It is a firmly established principle of the common law of New York that every individual "of adult years and sound mind has a right to determine what shall be done with his own body" (Schloendorff v. Society of N.Y. Hosp., 211 N.Y. 125, 129, 105 N.E. 92 [Cardozo, J.] ) and to control the course of his medical treatment (see, Matter of Storar, 52 N.Y.2d 363, 438 N.Y.S.2d 266, 420 N.E.2d 64; Schloendorff v. Society of N.Y. Hosp., 211 N.Y. 125, 105 N.E. 92, supra.) This tenet has been faithfully adhered to by our courts (see, Matter of Storar, 52 N.Y.2d 363, 438 N.Y.S.2d 266, 420 N.E.2d 64, supra; Matter of Harry M., 96 A.D.2d 201, 207, 468 N.Y.S.2d 359; see generally, People v. Eulo, 63 N.Y.2d 341, 357, 482 N.Y.S.2d 436, 472 N.E.2d 286; Hanes v. Ambrose, 80 A.D.2d 963, 437 N.Y.S.2d 784; Matter of Saunders v. State of New York, 129 Misc.2d 45, 50, 492 N.Y.S.2d 510; Matter of Winthrop Univ. Hosp. v. Hess, 128 Misc.2d 804, 490 N.Y.S.2d 996; Matter of Erickson v. Dilgard, 44 Misc.2d 27, 252 N.Y.S.2d 705 [Meyer, J.] ), and recognized by our Legislature (Public Health Law §§ 2504, 2805-d; CPLR 4401-a; 10 NYCRR 405.25 [a][7] ).

In Storar, we recognized that a patient's right to determine the course of his medical treatment was paramount to what might otherwise be the doctor's obligation to provide medical care, and that the right of a competent adult to refuse medical treatment must be honored, even though the recommended treatment may be beneficial or even necessary to preserve the patient's life (52 N.Y.2d, at p. 377, 438 N.Y.S.2d 266, 420 N.E.2d 64, supra). This fundamental common-law right is coextensive with the patient's liberty interest protected by the due process clause of our State Constitution (cf. Cooper v. Morin, 49 N.Y.2d 69, 80, 424 N.Y.S.2d 168, 399 N.E.2d 1188).

In our system of a free government, where notions of individual autonomy and free choice are cherished, it is the individual who must have the final say in respect to decisions regarding his medical treatment in order to insure that the greatest possible protection is accorded his autonomy and freedom from unwanted interference with the furtherance of his own desires (see, Matter of Erickson v. Dilgard, 44 Misc.2d 27, 28, 252 N.Y.S.2d 705, supra ; see genera lly, Olmstead v. United States, 277 U.S. 438, 478, 48 S.Ct. 564, 572, 72 L.Ed. 944 [Brandeis, J., dissenting]; Union Pac. Ry. Co. v. Botsford, 141 U.S. 250, 251, 11 S.Ct. 1000, 1001, 35 L.Ed. 734; Davis v. Hubbard, 506 F.Supp. 915, 930-933; Pratt v. Davis, 118 Ill.App. 161, 166, affd. 224 Ill. 300, 79 N.E. 562). This right extends equally to mentally ill persons who are not to be treated as persons of lesser status or dignity because of their illness (Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417). As noted by the Supreme Court of Oklahoma, "[i]f the law recognizes the right of an individual to make decisions about * * * life out of respect for the dignity and autonomy of the individual, that interest is no less significant when the individual is mentally or physically ill" (Matter of K.K.B., 609 P.2d 747, 752 [Okla] ).

In delineating their interest in medicating certain patients over their objections, respondents do not dispute the right of competent adults to control the course of their treatment and to refuse antipsychotic medication, but argue that an involuntarily committed mental patient is presumptively incompetent to exercise this right since in ordering involuntary retention, the court has implicitly determined that the patient's illness has so impaired his judgment as to render him incapable of making decisions regarding treatment and care. We conclude however, that neither the fact that appellants are mentally ill nor that they have been involuntarily committed, without more, constitutes a sufficient basis to conclude that they lack the mental capacity to comprehend the consequences of their decision to refuse medication that poses a significant risk to their physical well-being. Indeed, it is well accepted that mental illness often strikes only limited areas of functioning, leaving other areas unimpaired, and consequently, that many mentally ill persons retain the capacity to function in a competent manner (see, Brooks, Constitutional Right to Refuse Antipsychotic Medications, 8 Bull. of Am. Academy of Psychiatry & L. 179, 191 [hereafter cited as Constitutional Right ]; Rogers v. Okin, 478 F.Supp. 1342, 1361) [Mass.] ). Nor does the fact of mental illness result in the forfeiture of a person's civil rights (see, Mental Hygiene Law § 33.01), including the fundamental right to make decisions concerning one's own body (see, Du Bose, Of the Parens Patriae Commitment Power and Drug Treatment of Schizophrenia: Do the Benefits to the Patient Justify Involuntary Treatment, 60 Minn.L.Rev. 1149, 1160).

Although the historic view of many courts and psychiatrists was that a commitment decision necessarily includes a determination of incompetency (see, Plotkin, Limiting the Therapeutic Orgy: Mental Patients' Right to Refuse Treatment, 72 N.W.U.L.Rev. 461, 474-479 [hereinafter cited as Therapeutic...

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