Schizophrenia And The Law: Deciding Competency

by Christina Bruni Patient Expert

A court ruling in Massachusetts has implications for everyone diagnosed with schizophrenia and other mental illnesses, wherever we live. The whole problem with "Mary Moe" being legally required to obtain an abortion would have been avoided if this woman had in place a psychiatric advance directive, or mental healthcare proxy, that stated what her wishes would be if she were unable to speak for herself.

Unfortunately, as the Boston Globe story announced in a bold caption: "Disabled patients' wishes ignored." The family court ruled that "Mary Moe" should undergo an abortion and be sterilized. She was pregnant and psychotic and didn't think she was pregnant. She refused obstetric testing and care.

As a devout Catholic, she told court officials she would never have an abortion. She is 32 years old and has a son.

Her parents, who have custody of her son, stated that terminating the pregnancy is in "Mary's" best interest. In Massachusetts, courts have the final say in these kinds of cases. The original ruling was later overturned. In the first resolution, Norfolk judge Christina Harms cited "substantial delusional beliefs" in claiming "Mary" was not competent to make a decision about the abortion. Her reasoning was that if the woman were competent, she would choose to end the pregnancy.

In Massachusetts, this line of reasoning is titled "substituted judgment" and is required under Massachusetts law in guardianship cases involving "extraordinary treatment" such as abortion and administering antipsychotic medication. This rule applies to people who are legally deemed incapacitated because of mental illness, and other reasons like developmental disabilities and dementia.

Last Tuesday, the appeals court struck down the original ruling and remanded the case to family court.

"Substituted judgment" became the norm in Massachusetts as the result of a landmark case in the late 1970s. According to the Boston Globe article, the state Supreme Court "ruled that incompetent patients have the right to refuse treatment, and that the court must act as a surrogate to determine what the patient would choose."

Like I said in the lead-in to this SharePost, if "Mary Moe" had in place a psychiatric advance directive or mental health care proxy before she became delusional, her wishes would have to be taken into consideration.

In New York State, this kind of advance directive is a legal document that you fill out and get signed and notarized by a notary public with witnesses and the signature of your psychiatrist. My mother is my mental healthcare proxy tasked with telling professionals in the field what treatments I would or would not consent to if I were unable to state my preferences myself.

In no instance am I to be given Risperdal, Zyprexa or Clozaril. My first choice of bringing me out of an agitated state is to use drugs, like a shot in the thigh, and my last choice is restraint.

Should I become incompetent and get pregnant, it's written into the advance directive that my legal right to an abortion must be enforced. That's right folks. I wrote in a SharePost way back over four years ago when I first became the community leader here that I would rather be dead than psychotic. I'm not going to risk my mental health by carrying a baby to term without the ability to take the SZ meds.

Women have gotten paranoid and delusional while pregnant and have had to go into the hospital because of this. I'm lucky that even as a young woman I didn't want kids and that choice was solidified when I was diagnosed with schizophrenia.

With the presidential election coming up in the fall, I know I can only vote for the guy (and yet again it's a guy) who would respect my right to choose not to bring into this world a child who might develop schizophrenia. I'm one of the lucky ones: I've been in remission 20 years and I've recovered. My kid might not be so lucky. That's not a chance I'm willing to take.

I'll end this SharePost by recommending that all of you, men as well as women, investigate whether the state you live in recognizes a psychiatric advance directive as a legally-enforceable document. If it does, I would urge you to create one as soon as possible.

Christina Bruni
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Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.