Consent to Treatment

It is not because disputes in the area which Larry Gostin fashionably terms 'the interface' between psychiatry and the law are controversial that commentators should exercise caution. It is because such disputes tend to be acrimonious and personal. Emphasis should therefore be placed on the common ground which probably the majority of psychiatrists share with Gostin on the basis of his discussion paper (October Journal. p 742). For example, few would dispute the assertion that compulsory admission and compulsory treatment are separate processes, although many psychiatrists may well see them as more closely interrelated than does Gostin. Again, who would seriously challenge the view that detained patients very often understand the nature and purpose of proposed treatments, that any 'unsoundness' of mind is usually disabling in limited respects only and that the justification of compulsory treatment rests on establishing incapacity in terms of competence and an impaired ability to provide informed consent? At times during his paper Gostin puts forward generally accepted propositions with all the tentativeness of a bomb disposal squad approaching a suspicious package. In fairness, it may be that such caution reflects his experience in dealing with the psychiatric profession. The issue, therefore, is not so much the problems between law and psychiatry as how they might best be tackled. Gostin believes in tightening the law, bringing about a more substantial legal and lay input in the shape of strengthened multidisciplinary mental health tribunals, placing treatments characterized as 'irreversible, hazardous or not fully established' under particular controls and broadening the notion of the independent second opinion. Now Gostin is puzzled by the fact that psychiatrists who share his diagnostic assessment of the problems are not wildly enamoured of his suggested treatment. Doubtless, some are motivated by reasons imputed by critics and are anxious to hang on to such powers as they hold. Others are unhappy' for the somewhat more selfless reason that they are unimpressed by what happens to people clinically when the impersonal majesty of the law grinds into action. There are others, too, who believe that the patient may fare .better under a system of care that is prone to