title: The capacity to refuse psychiatric treatment: a guide to the law for clinicians and tribunal members.
abstract: OBJECTIVE
  In some Australian states clinicians and mental health tribunal members are already required to assess a person's decision-making capacity before involuntary treatment can be applied. Professionals in other jurisdictions will likely soon be required to do the same as mental health law reform in most Australian jurisdictions makes the assessment of decision-making capacity a central component of the process of providing unconsented psychiatric treatment. We provide a guide to the legal issues around the capacity to refuse psychiatric treatment to assist with this task.
  
  
  METHODS
  We review the legislation in the four Australian states most advanced in the mental health law reform process and use examples from clinical practice and the common law to describe how decision-making capacity should be assessed by these statutory standards.
  
  
  RESULTS
  Clinicians and tribunal members will primarily be required to judge whether a person with mental illness can understand the information relevant to the treatment decision and whether he or she can use or weigh that information to come to a decision. A person with a mental illness is presumed to have capacity, but that presumption can be rebutted. Capacity is specific to the decision at hand and cannot be determined by the nature of the decision made.
  
  
  CONCLUSIONS
  The information provided should assist clinicians and tribunal members to make determinations of decision-making capacity around treatment refusal in the context of mental illness.
authors.affiliation: The Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia Centre for Values, Ethics and the Law in Medicine, University of Sydney christopher.ryan@sydney.edu.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney Sydney Law School, University of Sydney, Sydney, Australia.
authors.forename: Sascha
authors.initials: S
authors.lastname: Callaghan
authors.affiliation: The Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia Capacity Australia, Crows Nest, Australia School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.
authors.forename: Carmelle
authors.initials: C
authors.lastname: Peisah
mesh_terms: D001315:Australia; D003657:Decision Making / Q000502:physiology; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence* / Q000523:psychology; D016743:Mental Competency / Q000331:legislation & jurisprudence* / Q000523:psychology; D001523:Mental Disorders / Q000523:psychology*; D016312:Treatment Refusal / Q000331:legislation & jurisprudence* / Q000523:psychology*
keywords: Decision-making capacity; assessment; psychiatric illness; treatment refusal