Patient rights versus patient needs: who decides?

The rights of patients both to receive and to refuse treatment, often seen as contradictory within the profession of psychiatry, are discussed, and the cases on which these principles have been based are reviewed. Difficulties and discrepancies in defining "emergency situations" in which treatment can be given against a patient's will are enumerated. It is clear that legal and psychiatric perceptions of emergency situations differ in many respects. Authors are now beginning to discuss concepts such as the patient's responsibilities in treatment, as well as the right of the caregiver to treat. Other related issues include adjudication of competency to refuse treatment, the rights of families, and the difficulties inherent in attempts to predict dangerousness.