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Book Review   |    
Mary T. Zdanowicz
Psychiatric Services 2008; doi:
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by Grant H. Morris, J.D., LL.M.; Lake Mary, Florida, Vandeplas Publishing, 2006, 206 pages, $34.95 softcover

Dr. Zdanowicz is executive director of the Treatment Advocacy Center, Arlington, Virginia.

Although the label "Medical Law Series 1" on the cover suggests that this is an academic text, it is clear from the introduction that Refusing the Right to Refuse is instead an antipsychiatry and antimedication polemic. Professor Morris presents a one-sided argument that reads like an advocacy brief supporting the right to refuse medication in almost all circumstances. The author lauds court decisions that support his position and ridicules court decisions that do not. But it is not just the courts that the author rails against. The author's experiences as a mental health hearing officer lead him to conclude that psychiatrists provide information about medication only to secure a patient's consent to treatment. He writes that psychiatrists' judgments about a patient's competence or dangerousness cannot be trusted because of their "protreatment bias." He even goes so far as to suggest that psychiatrists consider informed consent, patient autonomy, and medical self-determination "evils to be avoided."

Unfortunately, the author does just what he accuses psychiatrists of doing: he gives only enough information to secure the reader's agreement with his position. For example, he describes the potential side effects of antipsychotic medication in excruciating detail. In doing so, he creates the impression that these medications have no benefit other than as vehicles for social control, that psychiatrists have used them to ensure that their patients' "conduct in society would be appropriate." According to the book psychiatrists punish patients who do not agree with their medical recommendations by deeming those patients incompetent because they disagree. He ridicules the idea that some people with mental illnesses lack insight into their illness and that their capacity to make an informed medical decision may be impaired. In this portrayal, patients deny their illness for a litany of reasons that do not include the impact of the illness itself and certainly not because of anosognosia.

Not only does the book ignore the benefits of treatment, it does not acknowledge the consequences of nontreatment. There is a substantial discussion of a California case in which Kanuri Qawi, a man with schizophrenia and a violent history who was hospitalized for ten years under the state's Mentally Disordered Offenders statute, won the right to refuse treatment. The author is incredulous that Mr. Qawi, who was "clearly delusional and grandiose" and "expressed some persecutory beliefs," was held for ten years despite any incidents of violence, threats of violence, or property damage during that time. He fails to mention that shortly after his release from the hospital, Mr. Qawi brutally murdered his roommate.

This book will not help readers who seek to understand the state of the law in regard to administering medication over a person's objection—hyperbole is substituted for analysis. It will appeal to readers who share Professor Morris' bias.




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