Incompetence to refuse treatment: a necessary condition for civil commitment.

The recent U.S. District Court decision in A.E. and R.R. v. Mitchell held that psychiatric patients who are civilly committed under the Utah statute have no constitutional right to refuse treatment for the mental illness that led to their commitment. This unique law incorporates a judicial determination of competency to refuse treatment at the time of the commitment hearing and thus circumvents the objection to involuntary treatment raised in Rogers v. Okin. A number of psychiatrists have urged the use of this determination of competency, and recently the U.S. Court of Appeals for the First Circuit held it to be the sine qua non for the state's use of parens patriae power in compelling committed patients to accept neuroleptic medication.