People in the U.S. have the right to refuse treatment. Essentially, this means we can weigh our options and decide not to receive medical treatment. But what about incarcerated people? Do inmates have the right to refuse treatment when it comes to medical or mental health concerns where access to care is constitutionally mandated? This post explains.
Understanding Inmates’ Rights
Inmates’ rights are rooted in constitutional and statutory law. The U.S. Constitution doesn’t specifically address these rights, but several amendments have been interpreted to provide certain protections.
Inmates’ medical rights are based on:
- Eighth Amendment: This amendment protects Americans from cruel and unusual punishment. It has been interpreted to include the right of inmates to adequate medical care.
- Fourteenth Amendment. This amendment guarantees due process rights. It ensures that inmates are treated fairly and equitably, including in relation to medical decisions.
- State Laws. States may have their own laws governing the treatment of inmates. These laws can provide additional rights beyond federal laws related to treatments and the right to refuse them.
Limitations to inmates’ rights come into play when safety and security are concerned. Those issues are considered paramount. Also, jail officials have some discretion over how they interpret rights and what services they provide.
Austin Young, TK Health’s general counsel, said all patients, including incarcerated persons, have the right to bodily autonomy by way of the right to refuse medical treatment. He said:
“Exceptions are made in circumstances of patients who are determined to be mentally incompetent to make such decisions, and there are exceptions for communicable diseases and public health considerations. But generally, an incarcerated person is not discriminated against in his or her right to bodily autonomy and the right to refuse medical treatment. When an incarcerated person refuses medical treatment, the refusal is documented in the patient’s medical record.”
The Right to Refuse Treatment
The right to refuse treatment is a legal and ethical principle that says we have autonomy over our bodies and, therefore, have the right to decline medical treatment, even if healthcare providers recommend it.
Key concepts of the right to refuse treatment:
- Informed Consent. Medical professionals must fully inform patients about their condition, treatment options, risks and benefits, and any alternative options available. This information empowers patients to make informed decisions about their care.
- Competency. The person must be in sound mind to make informed decisions about their care. If not, healthcare providers can take steps to ensure an empowered party is making the decisions in the person’s best interest.
Donna Roberts, TK Health’s chief nursing officer, said that when a patient makes the choice to refuse, it is the nurse’s responsibility to educate the patient regarding the risks associated with refusing.
Common treatments they refuse include not taking medication, receiving wound care, vital sign checks, withdrawal assessments, or any number of services provided by medical professionals, Donna said.
“When refusing medical care, it is important that the nurse understand the reason for the refusal. Our goal is to provide the necessary education so the patient can make an informed decision. It is also important the nurse provide the education in a manner the patient understands.”
This right isn’t absolute. Inmates’ right to refuse treatment has limitations because of incarceration and the resulting environment. For example, an inmate may be deemed mentally incompetent because of severe mental health issues. If that’s the case, correctional authorities or healthcare providers can intervene to ensure the inmate receives the necessary care.
In another example, if an inmate’s refusal of treatment creates a significant risk to their health or the health and safety of others, corrections officials can override the refusal. For example, if an inmate refuses treatment for a contagious disease that is likely to spread in the jail, correctional officers can require them to undergo the treatment for the protection of themselves and the rest of the jail population.
Factors Influencing the Right to Refuse Treatment
Inmates can refuse treatment, but sometimes it’s administered anyway. Here are some other factors that might influence the right to refuse treatment.
Type of Treatment
The type of treatment matters when it comes to the right of refusal. Refusing medical treatment is pretty straightforward. As long as the person is competent, they can refuse medical treatment unless their condition is likely to harm others in the jail.
The right to refuse treatment gets murkier when it comes to mental health issues. While it’s generally assumed that inmates can refuse psychological or psychiatric treatment, their competency and ability to understand informed consent may come into question. If that’s the case, the jail also likely has standard procedures to follow.
These procedures probably include correctional officials requiring a mental health assessment to determine whether the inmate should receive involuntary treatment. In some cases, a legal guardian or advocate may be appointed to represent the inmate’s interests, particularly if there are questions about their capacity to make decisions.
Inmates also can refuse preventative measures like vaccinations or screenings. But, if there are public health implications, involuntary treatment may come into play.
Mental Competency
As outlined above, mental competency is a critical factor when determining whether an inmate can refuse treatment. Courts have attempted to establish legal standards in determining competency. These standards can vary by jurisdiction and change how officials may respond to the right to refuse treatment when mental competency is in question.
Health and Safety
Prison officials can prioritize health and safety over autonomy, even when an inmate tries to refuse treatment. This ability is critical when treatment refusal creates a public health risk in the communal living that jails require. For example, an inmate likely couldn’t refuse treatment for an infectious disease that would result in an outbreak throughout the jail.
Policies and Practices
Each jail and healthcare provider likely has policies and practices regarding the right to refuse treatment. Based on laws and practical experience, these regulations can change how the right may be exercised and upheld.
Ethical Considerations
Inmates’ right to refuse treatment is wrought with ethical concerns. These ethical considerations include:
- Informed Consent. Some inmates may not understand this concept, raising ethical concerns about whether their refusals are truly informed.
- Vulnerability. Inmates are often considered a vulnerable population, which creates ethical concerns about their right to refuse treatment.
- Protecting Health. When an inmate’s refusal to accept treatment could lead to significant harm or deterioration of their health.
- Emergency Interventions. When an inmate poses an immediate risk to themselves or others, healthcare providers may need to intervene involuntarily.
- Moral Justification. Healthcare providers must justify involuntary treatment, which generally goes against their training.
Inmates’ Right to Refuse Treatment
At TK Health, we understand the importance of bodily autonomy. We also recognize the need to care for vulnerable populations who may not fully understand their medical options and can do harm to others when exercising their right to refuse treatment. Our mission is to provide quality care at correctional centers throughout the region, even when difficult decisions must be made. To learn more about our services.
