Kendra’s Law and the right to medical decision-making
IN THE MATTER OF K.L. ,1 N.Y.3d 362, 806 N.E.2d 480, 774 N.Y.S.2d 472
On January 3, 1999 a man diagnosed with paranoid schizophrenia who had stopped taking his medication pushed Kendra Webdale to her death under an oncoming subway train. Later that year, the New York State Legislature enacted “Kendra’s Law.” This law provides for a system of court-ordered, assisted outpatient treatment (AOT) to help ensure that mentally ill people who are not confined in psychiatric hospitals take medication and treatment designed to help them survive safely in the community. Before a court can order AOT, they must hold a hearing at which a number of criteria must be established by clear and convincing evidence. It is not necessary for the court to find that the patient lacks the ability to make his/her own treatment decisions in order for it to issue the AOT order.
In October 2000, Dr. Glenn Martin, Director of the Department of Psychiatry at Queen Hospital Center, sought an order for AOT including therapy and medication for K.L.. K.L suffered from “schizoaffective disorder” with a history of psychiatric hospitalizations and non compliance with prescribed medication and treatment when not hospitalized. K.L. opposed the AOT order claiming, among other things, that Kendra’s Law violates his constitutional right to privacy to make decisions about his own medical treatment.
In a unanimous decision written by Chief Judge Judith Kaye, the New York State Court of Appeals upheld the constitutionality of Kendra’s Law. Judge Kaye wrote that while every adult of sound mind has the “right to determine what shall be done with his own body, the right is not absolute.” The “compelling state interests” of caring for its citizens who are unable to care for themselves, preventing violence, maintaining order and protecting the community from the “dangerous tendencies of some who are mentally ill” must be balanced against the limitation on the patient’s liberty. In this case, the limitation on the patient’s liberty is “minimal” because the court order does not authorize forcible administration of medication or treatment. If the patient refuses to comply with the AOT order, then a process for determining whether the patient needs to be confined to a hospital may begin if the physician so determines.
Learning Activities
Terms to Know
Critical Thinking
1. In 1986 the New York State Court of Appeals decided in Rivers v. Katz (67 N.Y.2d 485) that the State could not force a mentally ill patient confined to a psychiatric hospital to take medication unless a court first determined that he lacked the capacity to make a rational treatment decision for himself. How can Rivers and K.L. be reconciled since in K.L. the court found that a court order (AOT) may be issued even if the patient has the capacity to make his own treatment decisions?
This question asks the students why it is easier to get an AOT for a mentally ill person who is not so ill as to require confinement in a psychiatric institution than one for a mentally ill person confined in a psychiatric institution. Students can come up with some creative answers. One possible answer is that persons confined in a mental hospital who don’t take their medication are not a danger to the larger community outside of the mental hospital. If Kendra’s slayer was in a mental hospital and didn’t take his medication he would not have been able to push her into the subway train. The careful reader will come up with the fact that the AOT in KL doesn’t force anyone to take medication; in Rivers forced medication was at issue as stated above.
2. The summary of K.L. above mentions that before a court can order an AOT, they must hold a hearing at which a number of criteria must be established by clear and convincing evidence. What do you think the criteria should be in order to issue a court order requiring a free adult to take medication and treatment?
Kendra’s Law lists the criteria as follows, but students should be given the freedom to come up with their own:
Compare and Contrast
In Cruzan v. Director, Missouri Department of Health (497 U.S.261, 1990), the U.S. Supreme Court decided that an individual has a right to refuse medical treatment. However, when an individual is not competent to make treatment decisions, as was Nancy Cruzan who was in a coma, the state may make medical decisions to preserve his/her life unless there is clear and convincing evidence that the incapacitated individual would wish otherwise.
Compare K.L with Cruzan with regard to the balance between the state interests and the liberty interests involved. Students should come up with a list of the liberty interests and the state interests at stake in both of these cases and see where they are the same or different. (The summary above provides this information to the students with regard to K.L but with regard to Cruzan students will have to come up with their own ideas unless they read the Cruzan case in full.)
Some Suggested Answers:
State interests
q in Cruzan and KL – care for those who cannot care for themselves
q in Cruzan only– preserve human life; protect the helpless from those who would profit from their death
q in KL only – protect society from potentially violent people
Liberty interest
q in Cruzan and KL –the right to make decisions about one’s own treatment
q in Cruzan only – decision about the continuation of life; decision by a third party to refuse artificial nutrition and hydration
q in KL only– decision about whether to comply with order to take medication; decision by patient (not third party) who is legally competent