Unbuckling the 'Chemical Straitjacket': The Legal Significance of Recent Advances in the Pharmacological Treatment of Psychosis

Abstract

Antipsychotic medications figure prominently in the rapidly-growing field of mental disability law. Although the properties of antipsychotic medications are medical matters, legal scholars, judges, and practicing attorneys often need to understand what these drugs do. Yet the legal database - the principal or sole information source cited and consulted by legal thinkers - is often a source of confusion or misinformation about the actions of antipsychotic drugs and the scientific basis for prescribing them. The potential for misunderstanding antipsychotic treatment has increased since the arrival of "novel" or "aytpical" antipsychotic drugs, which cause fewer side effects than drugs that were commonly used a few years ago. Courts and legal scholars must evaluate antipsychotic drugs without being misled by distorted and increasingly outdated descriptions that appear in case law and secondary legal sources. This article discusses the legal significance of, and unresolved issues related to, the recent advances in the psychopharmacology of psychoses. The article summarizes psychiatry's current views on the nature of schizophrenia and its pharmacotherapy, the legal and policy consequences stemming from the high cost of novel antipsychotics, and potential sources of liability that might arise from financially motivated decisions about drug choices. The article then reviews litigation on the right to refuse treatment with antipsychotic medication, focusing on how the benefit and side effect profiles of novel agents have influenced courts' perceptions of and decisions about involuntary administration of these drugs. The article also presents a short quantitative summary of published cases that mention novel antipsychotic agents.

JEL Classification: H51, H72, I18, K13, O33