"Your Rights and Responsibilities in Making Medication Choices"
a P&A Self-Help Publication
Since October 1, 1993, inpatients in psychiatric units or hospitals who are eighteen years of age or older have a right to refuse medication. Public Act 93-369. These changes are incorporated into the Patient’s Bill of Rights, Conn. Gen. Stat. §17a-543. Various amendments have been made to this law since 1993 that include allowing inpatients who are age 16 and older to refuse medication under certain circumstances and clarifying the role of a conservator in making medication decisions.
MAKING INFORMED MEDICATION DECISIONS IF YOU DO NOT HAVE A CONSERVATOR
If it is the hospital’s opinion that medication be prescribed for you, they must ask you for your permission. In order for you to make an informed decision about whether or not to accept the hospital’s recommendation the hospital must provide you with the following information:
• the reason for the medication;
• the nature of the medication;
• the pluses and minuses of the medication;
• any alternative medication or treatment that is
medically acceptable for you;
• the risks of taking the medication; and
• the risks of not taking the medication.
After you are fully informed of the reasons and risks associated with the medication, you should respond whether or not you agree with their decision.
If you disagree, the hospital can:
• further discuss their concerns with you;
• decide that without medication your behavior puts you
or others in "direct threat or harm;" or
• find you unable to make the decision.
If the head of the hospital and two additional physicians determine that (1) you are able to give informed consent the medication and that you have refused to take the medication and (2), that there is no other “less intrusive” helpful treatment and (3) that without the medication your behavior will place you or others in a "direct threat of harm," the hospital must hold an internal hearing and/or file in Probate Court prior to medicating you.
INTERNAL PROCEDURES APPEAL PROCESS
The hospital may establish an internal hearing process to medicate you without your permission. The hospital’s internal procedure is a review of your decision to refuse medication. The hospital must:
• provide a hearing officer who is someone not
employed by the hospital;
• give you a list of advocacy services available to you
• give you 48 hours notice of the hearing;
• allow you and/or your advocate, if you have one, a
reasonable chance to discuss the selection of the individual
who is to be chosen as the hearing officer with the facility;
• permit you or your representative to question any witnesses
including one or both of the physicians who made the
medication decision; and
• provide you and your representative with a written decision.
If the resulting decision is that you should receive the medication and there is a substantial possibility that without it your mental condition will rapidly deteriorate, you may be medicated for no more than 30 days or until discharge. If you wish to appeal the decision, the hospital may medicate you against your wishes for 30 days while you appeal directly to the Probate Court. Probate Court must schedule a hearing for your appeal within 15 days of the date you filed the appeal.
IF YOU ARE UNABLE TO GIVE YOUR PERMISSION FOR MEDICATION
If the head of the hospital and two physicians agree that you are unable to give your permission for the medication and that the medication is necessary for your treatment, they may apply to Probate Court for the appointment of a conservator with specific authority to consent to medication for you. If you have a conservator already, the hospital must still petition the Probate Court to grant the conservator the authority to consent to medication. If your income level is low, you may be eligible for free legal representation in Probate Court.
Once a conservator has been appointed for you, he/she must:
• meet with you and your physician(s);
• review your written medical record;
• consider the risks and benefits of the medication and its
possible negative side effects;
• consider your preferences and your religious views; and
• consider your prognosis with or without the medication.
After this happens, the conservator will make a decision whether or not you should receive the medication. If your conservator decides that you should be given the medication, you may be medicated for no more than 120 days. Once you are discharged from the hospital, the conservator does not have the authority to force you to take medication. The 120 day authority ends upon your discharge. If you remain in the hospital beyond the 120 days and the hospital still feels you are not capable of providing informed consent to the medication, then the 120 day order can be extended for another 120 days without a hearing if the hospital petitions Probate Court. If you disagree with the second 120 day order you have the right to a hearing within 15 days from the date you request the hearing.
If an internal hearing is held pending the appointment of a conservator and you lose your right to refuse medication, you can receive medication for up to 30 days or until discharge.
APPEALS OF PROBATE COURT DETERMINATIONS
If you want to appeal a decision of the Probate Court to give you medication, you may require legal representation. This appeal is to the Connecticut Superior Court and it might be difficult for you to do this without legal assistance.
With the exception of the previously described criteria, you can only be medicated without your permission in an emergency situation. Emergency medication is intended to be for a short period of time to address an emergency of an extremely critical nature. Permission to provide involuntary medication in such a situation may be given by:
• your health care representative;
• conservator or guardian;
• next of kin;
• a person designated to make decisions for you;
• or a physician appointed by the Probate Court.
However, if obtaining the consent of one of these individuals would cause a medically harmful delay, permission to provide medication can also be made by a physician or the senior clinician on duty who has personally observed you.
Some hospitals may have internal policies governing the use of emergency medication. You have a right to be informed of their policy. Ask the hospital staff for further information or contact an advocate if you feel the use of emergency medication is unnecessary.
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