The psychiatrist's double bind: the right to refuse medication.

The assertion of a patient's right to refuse medication places a psychiatrist in a double bind because he or she knows that medication will often greatly relieve mental disturbance. Delaying medication until the patient is formally judged incompetent and a guardian appointed causes discomfort for the patient, the physician, staff, and other patients. On the other hand, forcing medication on a patient undermines the latter's sense of autonomy and may interfere with his or her constitutional rights, as a federal judge has ruled in the famous Boston State Hospital case. The right to refuse medication presents a uniquely intriguing case study of a need for accommodation between abstract constitutional concepts and practical realities and has opened a profound legal and ethical debate about the nature of "true freedom."