The right to refuse treatment: why psychiatrists should and can make it work.

There is a right to refuse treatment and this right already exists in the legal doctrine of informed consent. The basic legal justification for overcoming this right is the incompetence of the patient. Incompetence is also the central consideration in overcoming any constitutional right to refuse treatment. The constitutional theories of the right to refuse treatment are briefly presented and their implementation in different recent decisions is considered. A distinction is made between the requirement of proving incompetency and the requirement of appointing a neutral party as arbiter for incompetent patients. A recent constitutional ruling that recognizes this distinction and permits psychiatrists rather than neutral arbiters to make treatment decisions for patients is discussed as a model that should be acceptable to psychiatry.