Over the last decade issues raised under the rubric of the right to refuse treatment have presented very difficult legal and mental health system concerns. In 1983 the Oregon Mental Health Division promulgated an Administrative Rule dealing with informed consent. A portion of this rule provided a procedure which would make it possible to override treatment refusal, by civilly committed patients, in non-emergency situations. This procedure is similar to one of the three major national models in this area. Therefore data generated in Oregon will be useful in the national debate about this important topic. The study is a two-year project, organized in three components. The first will focus on a descriptive study of the characteristics of the refusing situation and of the override process for all refusal incidents (N=400) which have taken place in one of Oregon's state hospitals over the first 3 years (1983-85) that the new rule was in effect. The second component will focus on a comparison between refusing patients and an equal number of non-refusing patients. Refusing patients are defined, for this study, as persons whose treatment refusal has resulted in an override request based on the 1983 Administrative Rule. Non-refusing patients may have in fact refused treatment but refusal in these cases did not result in a request for an override decision. Subject characteristics of both groups will be compared as well as hospital course and post discharge mental health treatment experience. The third component will focus on the same groups of patients and explore the economic impact of the Administrative Rule on total program costs. The results of this study will have policy implications for the development of effective systems for managing the right to refuse treatment in other jurisdictions.
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