D.T. v. Department of Human Services

A person is unable to consent to significant medical procedures if they are unable to reasonably comprehend the risks and benefits of the proposed procedure. In administering significant procedures without consent, a hospital must consider all other less intrusive procedures if the protesting patient affirmatively raises an alternative procedure.

The Oregon State Hospital approved a proposal to administer psychopharmacological medications without petitioner’s consent, and petitioner challenged the decision. Oregon's Administrative Rules provide an exception to the general rule that an institution may administer a significant procedure without consent only for good cause, determined by a four-part test: 1) the person is deemed unable to consent; 2) the proposed procedure will likely restore the person’s health; 3) the procedure is the most appropriate and all other less intrusive procedures have been considered; and 4) the institution made a conscientious effort to obtain consent. Petitioner appealed the ALJ’s determination regarding factors 1 and 3 to the Court of Appeals. Regarding the first part, the Court found that a person is presumed competent, but DHS rebutted that presumption by showing that petitioner was unable to reasonably comprehend the risks and benefits of the proposed medication, he did not believe the medication would have any benefit, he did not grasp that his behavior was a symptom of his mental illness, and he believed there was nothing wrong with him. Regarding the third factor the Court found that DHS failed to consider all other less intrusive alternatives, because petitioner affirmatively raised the issue of being treated in a maximum security ward rather than the lower security ward. Petitioner had been treated in the maximum security ward earlier without resort to psychopharmacological medication, and all alternatives that were considered involved treatment while petitioner lived in the lower security ward. Reversed.