Legal,ethical and clinical implications of prescribing involuntary,life-threatening treatment: the case of the Sunshine Kid

Involuntary treatment is a concept often familiar to psychiatrists. In clinical practice, it usually involves the hospitalization and pharmacological management of patients with severe mental disorders. However, the scope of involuntary treatment is not limited to the management of mental illness alone. Psychiatric patients afflicted with medical illnesses may require hospitalization and invasive procedures for optimal management of these disorders. The following case illustrates a dilemma in which a psychotic patient refuses life-saving medical treatment; however, the treatment itself carries significant risk of morbidity and mortality. This article reviews the ethical, legal and clinical implications of making such difficult treatment decisions.