Biomedical Ethics The Case of Scott Starson

In 1999, Scott Starson was involuntarily committed to a psychiatric hospital in Ontario after he had been found not criminally responsible for two counts of uttering death threats. Starson had a history of psychiatric disorders, and had recently been diagnosed with bipolar disorder. Starson recognized his disorder and voluntarily underwent psychotherapy, but he refused any medication for the condition. Starson, a gifted theoretical physicist, believed the medications would destroy his ability to pursue his research, which in his opinion was the only thing that gave his life meaning. Physicians and officials believed Mr. Starson was unable to genuinely appreciate the value of treatment, so they petitioned to have his treatment decisions transferred to a surrogate. The petition was granted, but Mr. Starson appealed in a case that made its way up to the Supreme Court of Canada, which overturned the decision and asserted that Mr. Starson was not incompetent to make medical decisions. A patient, they argued, is not required to make a decision that is in their "best interests" as determined by the physician, and therefore they are allowed to disagree with a treatment recommendation. Mentally ill patients, then, must also be allowed to make medical decisions that disagree with doctors unless a clear inability has been demonstrated. Explore this case and the consequences it represents for the concept of informed consent and the notion of competence in Canada. Should doctors be allowed to impose treatments in such cases?

Introduction

The Scott Starson case is an extraordinarily interesting example of current biomedical ethics dilemmas. On one hand, Scott Starson...

The fact that Scott Starson deals with mental issues is not debated; in fact, Professor Starson himself readily acknowledges the fact. However, the real dilemma lies in who has the power to facilitate a treatment program for the patient. The psychiatrist originally argued that Scott Starson was incapable of understanding the treatment that they prescribed and/or the effects of his decision. However, Starson vehemently denies the psychiatrists decision; in fact, he questions the entire psychiatric field in general. The psychiatrist argued that he was incapable of making the treatment decision and thus was in a position to make it for him. However, Starson appealed this decision and ultimately won.
Arguments for Mandatory Treatment for Mentally Inept Patients

There are many reasons in which a patient could not be trusted to make the best decision for their own mental well-being. The legal test for determining whether a person is capable of making his or her own treatment decisions is found in s. 4(1) of the Health Care Consent Act, 1996, S.O. 1996, c.2 (the Act); it is a two-part test: a person is "capable with respect to treatment" only if the person is both "able to understand the information that is relevant to making a decision about the treatment" and "able to appreciate the reasonably foreseeable consequences of a decision or lack of decision" (Center for Cognitive Liberty & Ethics, 2000):

4. (1) A person is capable with respect to treatment, admission to a care facility or a personal assistance service if the person is able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.

Whether or not Professor Starson is really capable of understanding the information that is available to his treatment options is debatable to say the least. Although Starson is undoubtedly intelligent in some regards, there are situations in life in which this type of intelligence does not seem to apply. Although Professor Starson…