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A Tough Pill to Swallow 149
placed on evaluating them in terms of the level of danger which they pose. 17 The
next stage is the stabilization phase, in which the person is medicated to reduce
their positive psychotic symptoms. Adherence to medication is critical at this
stage. 18 Finally, there is the stable phase, which is the focus of this paper. Relapse
prevention is an important goal during this phase. 19
Individual response to medication is highly variable, but the use of
antipsychotic medications is an essential part of a treatment plan. 20 While
undergoing treatment, patients are typically provided with information
concerning the nature of their disorder, as well as the risks and benefits of
treatment so that they may play an informed and participatory role in their
treatment. 21 This means that the theoretical patient I refer to in this paper can
reasonably be assumed to have been informed of the dangerous consequences
which would accompany failing to adhere to his medication. If a patient had not
been so informed and remained ignorant of the gravity of his mental illness and
the importance of medication, he obviously should not be faulted if he fails to
adhere to it.
While the patient still has the right to determine his own course of
treatment or refuse it altogether, 22 this right is not absolute. In cases where the
patient is not competent to make decisions the decision may be made for him. A
determination of incompetence would involve consideration of whether he is
mentally impaired to the extent that he does not understand the nature of his
condition or the consequences of obtaining or not obtaining treatment. 23 For the
purposes of this paper, I assume that the person in question is competent to make
treatment choices.
Nevertheless, just because the patient has the right to choose to abstain from
medication, does not mean that he should be able to do so with impunity. To the
extent that exercising a right entails a foreseeable risk of harm to others, I think it
is plain that a person ought to be held accountable for exercising that right.
As the issue of culpability in an avoidable mentally disordered state is
analyzed, it may be helpful to keep in mind a specific scenario. Imagine a person
who has schizophrenia, paranoid type, or a person with a condition similar to that
of Li or Joubert. As with Joubert (but unlike Li), this person has been diagnosed
by his doctor who has prescribed an anti-psychotic medication to be taken
regularly. The medication is effective and alleviates most symptoms of the
disorder, leaving him in a mentally stable phase. The medication produces some
17
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19
20
21
22
23
Ibid at 20S.
Ibid.
Ibid at 22S.
Ibid at 19S.
Ibid.
See The Mental Health Act , CCSM c M110 s 26.
Ibid at s 27(2).