Journal of Bioethical Inquiry

, Volume 8, Issue 1, pp 87–93 | Cite as

One Flu Over The Cuckoo’s Nest: Comparing Legislated Coercive Treatment for Mental Illness with that for Other Illness



Many of the world’s mental health acts, including all Australian legislation, allow for the coercive detention and treatment of people with mental illnesses if they are deemed likely to harm themselves or others. Numerous authors have argued that legislated powers to impose coercive treatment in psychiatric illness should pivot on the presence or absence of capacity not likely harm, but no Australian act uses this criterion. In this paper, I add a novel element to these arguments by comparing the use of the harm to others justification for coercive treatment in mental illness with its use in illness due to infectious disease, and suggest a double standard applies. People with mental illness are subjected to coercive treatments at levels of risk to others far, far lower than would precipitate coercive treatment in people with influenza. In effect, this element of mental health legislation represents an example of sanism—state-sanctioned discrimination against people with mental illnesses.


Mental competency Informed consent Mental disorders Ethics Legislation Human rights Dangerous behaviour 


  1. Australian Capital Territory Department of Health. 2009. Review of the Mental Health (Treatment & Care) Act 1994.Google Scholar
  2. Australian Capital Territory Government. 2009. The framework of mental health and related legislation in the ACT. An options paper. Australian Capital Territory Government.Google Scholar
  3. Bartlett, P. 2003. The test of compulsion in mental health law: Capacity, therapeutic benefit and dangerousness as possible criteria. Medical Law Review 11: 326–352.PubMedCrossRefGoogle Scholar
  4. Bellhouse, J., A.J. Holland, I.C.H. Clare, M. Gunn, and P. Watson. 2003a. Capacity-based mental health legislation and its impact on clinical practice: 1) admission to hospital. Journal of Mental Health Law 10: 9–23.Google Scholar
  5. Bellhouse, J., A.J. Holland, I.C.H. Clare, M. Gunn, and P. Watson. 2003b. Capacity-based mental health legislation and its impact on clinical practice: 2) treatment in hospital. Journal of Mental Health Law 24: 24–37.Google Scholar
  6. Buchanan, A. 2002. Psychiatric detention and treatment: A suggested criterion. Journal of Mental Health Law 11: 35–42.Google Scholar
  7. Cheng, A.C., D.E. Dwyer, A.T.C. Kotsimbos, M. Starr, T.M. Korman, J.P. Buttery, C.R. Jenkins, V.L. Krause, and P.D.R. Johnson. 2009. ASID/TSANZ guidelines: Treatment and prevention of H1N1 influenza 09 (human swine influenza) with antiviral agents. Medical Journal of Australia 191 (Rapid Online Publication 18 June 2009—Updated 13 August 2009).Google Scholar
  8. Dawson, J. 2008. Community treatment orders and human rights. Law in Context 26(2): 148–159.Google Scholar
  9. Dawson, J., and G. Szmukler. 2006. Fusion of mental health and incapacity legislation. The British Journal of Psychiatry 188: 504–509.PubMedCrossRefGoogle Scholar
  10. Donnelly, C.A., A.C. Ghani, G.M. Leung, A.J. Hedley, C. Fraser, S. Riley, L.J. Abu-Raddad, L.-M. Hon, T.-Q. Thach, P. Chau, K.-P. Chan, T.-H. Lam, L.-Y. Tse, T. Tsang, S.-H. Liu, J.H.B. Kong, E.M.C. Lau, N.M. Ferguson, and R.M. Anderson. 2003. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet 361: 1761–1766.PubMedCrossRefGoogle Scholar
  11. Gostin, L.O. 2003. When terrorism threatens health: How far are limitations on human rights justified. The Journal of Law, Medicine & Ethics 31(4): 524–528.CrossRefGoogle Scholar
  12. Grisso, T., and P.S. Appelbaum. 1995. The MacArthur treatment competence study. III. Law and Human Behavior 19(2): 149–174.PubMedCrossRefGoogle Scholar
  13. Hare, R. 1991. The revised psychopathy checklist. Toronto: Multi-Health Systems.Google Scholar
  14. Harris, G.T., M.E. Rice, and V.L. Quinsey. 1993. Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument. Criminal Justice and Behavior 20: 315–335.CrossRefGoogle Scholar
  15. Hunter and New England Area Health Service v A. 2009. NSWSC 761.Google Scholar
  16. Kämpf, A. 2008. The disabilities convention and its consequences for mental health laws in Australia. Law in Context 26(2): 10–36.Google Scholar
  17. Kelly, T. 2007. Second reading speech for the Mental Health Bill 2007 (NSW). Hansard of the New South Wales Legislative Council NSW Legislative Council Hansard, Tuesday 5 June 2007.Google Scholar
  18. Large, M., C.J. Ryan, O. Nielssen, and R. Hayes. 2008. The danger of dangerousness. An argument against the dangerousness criterion in mental health acts. Journal of Medical Ethics 34: 877–881.PubMedCrossRefGoogle Scholar
  19. Large, M.M., C.J. Ryan, M. Paton, O. Nielssen, and S. Singh. 2010. The predictive value of risk categorization in schizophrenia. Harvard Review of Psychiatry (in press).Google Scholar
  20. Melamed, Y., R. Kimchi, D. Shnit, M. Moldavski, and A. Elizur. 1997. Insight and competence to consent to psychiatric hospitalization. Medicine and Law 16(4): 721–727.PubMedGoogle Scholar
  21. Mental Health Consumer Outcomes Task Force. 1991. National mental health statement of rights and responsibilities. Canberra: Australian Goverment Publishing Service.Google Scholar
  22. Mill, J.S. 1859. On liberty.Google Scholar
  23. Milne, D., A. O’Brien, and B. McKenna. 2009. Community treatment orders and competence to consent. Australasian Psychiatry 17(4): 273–278.PubMedCrossRefGoogle Scholar
  24. Monahan, J., H.J. Steadman, P.C. Robbins, P. Appelbaum, S. Banks, T. Grisso, K. Heilbrun, E.P. Mulvey, L. Roth, and E. Silver. 2005. An actuarial model of violence risk assessment for persons with mental disorders. Psychiatric Services 56(7): 810–815.PubMedCrossRefGoogle Scholar
  25. New South Wales Health. 2004a. Review of the Mental Health Act 1990—Discussion paper 2: The Mental Health Act 1990.Google Scholar
  26. New South Wales Health. 2004b. Review of the Mental Health Act 1990—Discussion paper 1: Carers and information sharing.Google Scholar
  27. New South Wales Health. 2006. Review of the Mental Health Act 1990—Report.Google Scholar
  28. Nielssen, O., D. Bourget, T. Laajasalo, M. Liem, A. Labelle, H. Häkkänen-Nyholm, F. Koenraadt, and M.M. Large. 2010. Homicide of strangers by people with a psychotic illness. Schizophrenia Bulletin (in press), accessed August 29, 2010, doi: 10.1093/schbul/sbp112.
  29. Owen, G.S., G. Szmukler, G. Richardson, A.S. David, P. Hayward, J. Rucker, D. Harding, and M. Hotopf. 2009. Mental capacity and psychiatric in-patients: Implications for the new mental law in England and Wales. The British Journal of Psychiatry 195(3): 257–263.PubMedCrossRefGoogle Scholar
  30. Peiris, J.S.M., K.Y. Yuen, A.D.M.E. Osterhaus, and K. Stîhr. 2003. The severe acute respiratory syndrome. The New England Journal of Medicine 349: 2431–2441.PubMedCrossRefGoogle Scholar
  31. Perlin, M.L. 1992. On “sanism”. Southern Methodist University Law Review 46: 373–407.Google Scholar
  32. Perlin, M.L. 1999. “Half-wracked prejudice leaped forth”: Sanism, pretextuality, and why and how mental disability law developed as it did. Journal of Contemporary Legal Issues 10: 3–36.Google Scholar
  33. Perlin, M.L. 2008. Representing criminal defendants in incompetency and insanity cases: some therapeutic jurisprudence dilemmas. New York Legal Studies Research Paper Series 07/08 (#30).Google Scholar
  34. Reynolds, C. 2004. Public health—law and regulation. Sydney: Federation.Google Scholar
  35. Richardson, G. 2002. Autonomy, guardianship and mental disorder: one problem, two solutions. Modern Law Review 65(5): 702–723.PubMedCrossRefGoogle Scholar
  36. Ryan, C.J. 2010. Capacity as a determinant of non-consensual treatment of the mentally ill in Australia. Psychiatry, Psychology and Law (in press).Google Scholar
  37. Szmukler, G., and F. Holloway. 1998. Mental health legislation is now a harmful anachronism. Psychiatric Bulletin 22(11): 662–665.CrossRefGoogle Scholar
  38. United Nations. 2006. United Nations convention on the rights of persons with disabilities.Google Scholar
  39. United Nations General Assembly. 1948. The universal declaration of human rights.Google Scholar
  40. United Nations General Assembly. 1991. Principles for the protection of persons with mental illness and for the improvement of mental health care.Google Scholar
  41. Victorian Government. 2009. Review of the Mental Health Act 1986. Government response to the Community consultation report. Melbourne.Google Scholar
  42. Wand, T., and M. Chiarella. 2006. A conversation: Challenging the relevance and wisdom of separate mental health legislation. International Journal of Mental Health Nursing 15(2): 119–127.PubMedCrossRefGoogle Scholar
  43. Webster, C., K. Douglas, and D. Eaves. 1997. HCR-20: Assessing risk for violence (version 2). Vancouver: Simon Fraser University, Mental Health Law and Policy Institute.Google Scholar
  44. World Health Organisation. 2005. International health regulations.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Discipline of Psychiatry and Centre for Values, Ethics and the Law in MedicineUniversity of SydneyWestmeadAustralia

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