Rivers v. Katz
504 N.Y.S.2d 74, 67 N.Y.2d 485, 495 N.E.2d 337 (1986)
Rule of Law:
The due process clause of the New York State Constitution provides involuntarily committed mental patients a fundamental right to refuse antipsychotic medication, which can only be overridden if a court judicially determines the patient lacks the capacity to make reasoned treatment decisions or in emergencies under the state's police power.
Facts:
- Mark Rivers, Florence Zatz, and Florence Grassi were patients at the Harlem Valley Psychiatric Center, having been involuntarily committed by court orders finding them in need of care due to mental illness and impaired judgment.
- Mark Rivers refused to be medicated with antipsychotic drugs, but his objections were overruled following an administrative review process prescribed by the Commissioner of Mental Health regulations, and he was subsequently medicated.
- Florence Zatz also refused antipsychotic medication, and her refusal was similarly overruled after administrative review, leading to her being medicated.
- Florence Grassi refused treatment with antipsychotic drugs, but her protest was overruled after the administrative review process, and she was thereafter forcibly medicated with Prolixin Hydrochloride.
- The State's basis for administering drugs to Grassi was to 'bring about a re-integration of her current psychotic disorder' and improve her condition, and for Rivers and Zatz, because they were 'seriously mentally ill' and their condition 'would deteriorate if such medication were discontinued.'
- No claim was made that the antipsychotic drugs were administered to these patients because of circumstances implicating the State's police power (e.g., dangerousness to self or others).
Procedural Posture:
- Mark Rivers and Florence Zatz commenced a declaratory judgment action against the Commissioner and officials of the Harlem Valley Psychiatric Center to enjoin the nonconsensual administration of antipsychotic drugs and to obtain a declaration of their common-law and constitutional right to refuse medication.
- Special Term (trial court) denied a request for class certification and, upon defendant’s motion for summary judgment, dismissed the complaint, reasoning that involuntary retention orders necessarily determined patients were unable to competently make treatment choices.
- Florence Grassi commenced an Article 78 proceeding, alleging that the forcible use of antipsychotic medication violated her common-law and constitutional right to determine her own course of treatment.
- Her application for preliminary injunctive relief was denied after a hearing, and the proceeding was dismissed upon respondents’ cross motion for the same reasons expressed by Special Term in dismissing the Rivers/Zatz complaint.
- The Appellate Division (intermediate appellate court) consolidated appeals by Rivers, Zatz, and Grassi from the respective Special Term order and judgments, and affirmed the lower court's decisions for reasons stated at Special Term.
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Issue:
Does the New York State Constitution's due process clause afford involuntarily committed mental patients a fundamental right to refuse antipsychotic medication, and if so, under what circumstances may the State forcibly administer such drugs?
Opinions:
Majority - Alexander, J.
Yes, the due process clause of the New York State Constitution (art I, § 6) affords involuntarily committed mental patients a fundamental right to refuse antipsychotic medication, which the State may only override under specific, compelling circumstances. The court established that New York's common law firmly recognizes every individual's right to determine medical treatment for their own body, a right coextensive with the liberty interest protected by the State's Due Process Clause (Schloendorff v Society of N.Y. Hosp.; Matter of Storar). This right extends to mentally ill persons, as neither mental illness nor involuntary commitment, without more, constitutes a sufficient basis to conclude they lack the mental capacity to comprehend treatment decisions. The court rejected the argument that an involuntary retention order implicitly determines incompetence. The State may override this right under its police power if the patient presents a danger to themselves or others, or engages in dangerous conduct within the institution, such as in emergency situations, but this justification is temporary. More broadly, under the State's parens patriae power, forceful administration of mind-affecting drugs is justified only by a judicial determination that the individual lacks the capacity to decide whether to take the drugs. This determination is uniquely judicial, not medical. The administrative review procedures (14 NYCRR 27.8) were deemed insufficient to protect due process rights because they lack articulated standards for evaluating the need for drugs, least intrusiveness, side effects, and duration of use. The court held that if police power is not implicated and the patient refuses consent, there must be a de novo judicial hearing, with patient representation by counsel, where the State bears the burden of demonstrating by clear and convincing evidence the patient's incapacity to make a treatment decision. If incapacity is found, the court must then determine, also by clear and convincing evidence, if the proposed treatment is narrowly tailored to the patient's liberty interest, considering best interests, benefits, adverse side effects, and less intrusive alternatives.
Analysis:
This case significantly strengthened the autonomy rights of involuntarily committed mental patients in New York, shifting the burden and authority from medical professionals to the judiciary for competency determinations regarding treatment refusal. By requiring a judicial hearing and clear and convincing evidence, it established robust procedural safeguards rooted in the state's due process clause, diverging from the previous presumption of incompetence upon involuntary commitment. The distinction between police power and parens patriae justifications for forced medication is critical, ensuring forced treatment for therapeutic reasons is subject to higher scrutiny, thereby influencing future mental health legislation and patient rights litigation across the state and potentially serving as a model elsewhere.
