Involuntary treatment or mandatory treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors. Globally and even within countries, what is meant by the term "involuntary treatment" is not agreed upon. In/voluntary when applied to medical treatments could refer to a purely legal perspective, an entirely ethical lens, or with components of both. Therefore use of the term is best accompanied by specification to avoid confusion. Some countries have general legislation allowing for any treatment deemed necessary if an individual is unable to consent to a treatment due to a perceived lack of capacity, other legislation may specifically deal with involuntary psychiatric treatment of individuals who have been diagnosed with a mental disorder. Psychiatric treatment normally happens in a psychiatric hospital after some form of involuntary commitment, though individuals may be compelled to undergo treatment outside of hospitals via outpatient commitment. The diagnosis of mental disorders can be carried out by some form clinical practitioner, or in some cases law enforcement or others, to be a danger to themselves or to others is permitted in some jurisdictions, while other jurisdictions have more recently allowed for forced treatment for persons deemed to be "gravely disabled" or asserted to be at risk of psychological deterioration. A patient may be detained because they are diagnosed with a psychiatric disorder or infectious disease.
History
In the early 20th century, many countries passed laws allowing the compulsory sterilization of some women. In the US more than half the states passed laws allowing the forced sterilization of people with certain illnesses or criminals as well as sterilization based on race. Forcible sterilization took place in the United States until at least 1981, more than 64 thousand people were forcibly sterilized. Denmark sterilized 60 thousand people between 1935 and 1976. During Nazi rule in Germany as part of their eugenics program about 600 thousand people were compulsorily sterilized. Involuntary euthanasia was carried out in Nazi Germany for those who had certain psychiatric disorders or learning disabilities as part of the Aktion T4 program. This program was run by Karl Brandt, a medical doctor, and Philipp Bouhler. Victims were murdered together in gas chambers and this program was a prototype for the extermination camps such as Auschwitz where the Holocaust took place. As part of Action 14f13, physicians involved in the euthanasia program visited concentration camps where they looked at documentation provided by SS camp doctors and approved the murder of camp inmates on the grounds of race, behavior and ability to work using the euthanasia program's facilities. Throughout the latter half of the 20th century, homosexual men in the UK were given the choice between chemical castration with female sex hormones or prison including, notably, Alan Turing. Until 2004, every European state required that transgender people must be sterilized or provably infertile to have their preferred gender formally recognized. This practice continued in Sweden until 2012 and Denmark until 2014. Japan currently requires transgender people to be sterilized and have their ovaries removed to be recognized as a different gender.
Ethics and the law
The Hippocratic Corpus, an ancient Greek text discussing medical ethics, advises that physicians conceal most information from patients to give the patients the best care. The 1767 English case Slater vs Baker and Stapleton found against two doctors who had refractured a patient's leg without consent. Thomas Percival was a British physician who published a book called Medical Ethics in 1803, which makes no mention of soliciting for the consent of patients or respecting their decisions. Percival said that patients have a right to truth, but when the physician could provide better treatment by lying or withholding information, he advised that the physician do as he thought best. Benjamin Rush, an 18th-century United States physician, in a lecture entitled "On the duties of patients to their physicians", stated that patients should be strictly obedient to the physician's orders; this was representative of much of his writings. The US Canterbury v. Spence case established the principle of informed consent in US law. Earlier legal cases had created the underpinnings for informed consent, but his judgment gave a detailed and thought-through discourse on the matter. The judgment cites cases going back to 1914 as precedent for informed consent.
Infectious disease
In response to the bubonic plague, some city states restricted movement of people into them using cordon sanitaires, and separated those were suspected of being infected into makeshift camps. Merchant sailors were made to isolate in lazarettos, hospitals for infectious diseases. England created quarantine regulations in 1663 to confine ships suspected of being infected with the plague. In response to cholera outbreaks in the 1830s, some European cities people with symptoms were forced into lazarettos. An 1853 law in the United Kingdom made vaccination compulsory with those refusing to comply receiving fines. People with symptoms of tuberculosis have been detained in New York from 1902. During the Spanish flu pandemic western cities implemented social distancing and closed schools, churches, theatres and restricted public gatherings. During the COVID-19 pandemic many countries implemented lockdowns restricting movement, enforcing working from home and social distancing.
Mental health
In 1789, during the French Revolution, the French government issued a directive for the management of the insane. This directive ordered that the insane be incarcerated and treated. Bethlem Royal Hospital is a mental hospital in the United Kingdom, which started exclusively treating mental illness in 1377. In 1818, Urban Metcalf, a patient at Bethlam, published a book describing his experience there. He described physical restraint of patients who were attached to walls. This followed a report by the government in 1815 describing conditions in asylums in the UK.
Political use
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