Forced Treatment vs Patient Autonomy: Ethical and Legal Dilemma in Mental Healthcare

Among today’s most controversial issues in mental health is the ethical and legal tension between forcibly treating people for mental health issues and respecting their right to make their own choices about treatments. Many mental health clinicians believe that once a patient becomes mentally ill, he or she has lost some level of capacity to make competent decisions about treatment. In the past, mental health systems tended to be paternalistic, with a strong emphasis on protecting the individual and controlling him/her by virtue of the system's responsibility to do no harm while still providing care. This resulted in widespread violation of patients' rights through coercion, abuse, and neglect. The last several years have seen a shift from a medical model to one based on human rights. To this end, the International Human Rights Instruments, including the UN Convention on the Rights of Persons with Disabilities (UNCRPD), have played a huge role in redefining Mental Health Laws. Through this change, India has passed the Mental Health Care Act 2017 which incorporates Legal Capacity, Informed Consent, Advance Statements and Supported Decision Making as the foundation of this new model. The Mental Health Care Act continues to allow for Involuntary Hospitalization and Involuntary Treatment under specific circumstances and therefore, reflects a careful consideration between Autonomy and care. In this article, we will assess the ethical basis for and legal structures around forced treatment of people with mental illness as well as their rights regarding making decisions about themselves. We will discuss how international standards on human rights, laws in India, and the courts have interpreted these laws will also be evaluated for problems enforcing them. This paper will argue that while forced treatment can be legally justified in the right situations, people should have the "default" right to make their own choices about receiving treatment by rules instead of being given no choice regarding forced treatment. If someone is being treated involuntarily, then that must be justified within reasonable limits, justified based on necessity as well as proportionality, along with procedural safeguards and respect for human dignity. Finally, I will discuss the importance of developing better community-based treatment facilities and creating better systems of oversight to encourage improved decision-making processes so that involuntary treatment is not necessary anymore in caring for individuals with mental illnesses.