Voluntary and Involuntary Hospitalization

• Published in: Psychiatry and the Law pp. 53 - 61
• Main Authors: Yarnell, Stephanie, Kapoor, Reena
• Format: Book Chapter
• Language: English
• Published: Switzerland Springer International Publishing AG 2017; Springer International Publishing
• Subjects: 14th Amendment; Clinical psychology; Due process; Forensic medicine; Informed consent; Involuntary hospitalization; Psychiatric hospitalization; Psychiatry; Zinermon v. Burch
• ISBN: 9783319631479; 3319631470
• DOI: 10.1007/978-3-319-63148-6_5

This chapter begins by reviewing a scenario commonly encountered in emergency rooms across the United States: what to do when a patient agrees to voluntary psychiatric admission but lacks the capacity to make this decision. The landmark US Supreme Court case Zinermon v. Burch is used to guide this discussion. In brief, Mr. Burch was allowed to admit himself to the hospital voluntarily, even though the mental health staff knew that he believed he was signing into “heaven.” Mr. Burch later sued the hospital and treatment staff, claiming he had been deprived of liberty without adequate due process. The US Supreme Court agreed with Mr. Burch, finding that his Constitutional rights were violated because he was detained in the hospital based on voluntary admission paperwork that he was incompetent to sign; in short, patients must give informed consent for voluntary hospitalization. However, this was not always the case. This chapter briefly discusses the complicated historical interface of psychiatry and involuntary hospitalizations, as well as the resulting complex framework of legal (e.g., parens patriae, police powers) and ethical (e.g., beneficence) justifications for involuntary hospitalization, which must be balanced against patients’ rights to make their own medical decisions and remain free from confinement. Views of both patients and physicians, as well as outcomes, are subsequently discussed, with a final suggestion that, when in doubt, psychiatrists should proceed with caution, using involuntary hospitalization protocols to ensure that the patient’s due process rights are adequately protected.