Starson v. Swayze
Encyclopedia
Starson v. Swayze, 2003 SCC 32, [2003] 1 S.C.R. 722 was an important case at the Supreme Court of Canada
that considered the legal requirements for determining if a person is capable of making decisions regarding their medical treatment. On June 6, 2003, the Supreme Court of Canada published its decision in the case. In a 6 to 3 decision, the majority held that Professor Scott Starson (a.k.a. Scott Jeffery Schutzman) had the right to refuse the medication.
physicist, who was regarded by his colleagues as a genius. Other physicists permitted Starson to use the title “Professor Starson” in light of his contributions to the field. Though Starson appreciated that he was not 'normal' and that he had problems dealing with people. He acknowledged that he had mental health issues, but refused to accept his condition as an illness. He also refused to consent to the course of medications that his physicians recommended for fear that it would diminish his thinking. He would have accepted psychotherapy but no medication.
The Board decided that because Starson did not recognize that he was ill and that he needed treatment, the Board decided that Starson was not able to understand the consequences of consent; he failed to appreciate the risks and the benefits and therefore he lacked the capacity to make a decision as to treatment.
Holding: No.
Prior to the Starson decision a person who does not acknowledge illness cannot accept the consequences of treatment (Khan). The court recognized that a person who has accepted the manifestations of illness, although not the final diagnosis, does not forego capacity to refuse treatment. All the patient must do is be able to:
The patient does not have to weigh the benefits properly or rationally.
The majority also noted that psychiatrists do not always agree on diagnoses (as if to devalue the importance that the court should place on their opinions). So long as the patient can recognize the symptoms, then the court will have difficulty finding incapacity.
Major accused McLachlin of doing what the Board did: of deciding what was in the patient’s best interests.
was killed by aliens), where Major’s majority did not.
Both McLachlin and Major agree that the issue is not a “best interests of the patient” standard.
She felt, however, that the patient may be able to understand the general nature of the illness but cannot recognize that he has the illness. This means that the patient cannot appreciate the benefits of the treatment or the need for treatment.
.”
The court was split on the right to self-determination and the patients’ best interests. Once you start thinking in the patients’ best interests, you become less like a lawyer and more like a psychiatrist.
According to Daphne Jarvis, a legal counsel to the Schizophrenia Society of Canada,
According to an article in The Ottawa Citizen,
Supreme Court of Canada
The Supreme Court of Canada is the highest court of Canada and is the final court of appeals in the Canadian justice system. The court grants permission to between 40 and 75 litigants each year to appeal decisions rendered by provincial, territorial and federal appellate courts, and its decisions...
that considered the legal requirements for determining if a person is capable of making decisions regarding their medical treatment. On June 6, 2003, the Supreme Court of Canada published its decision in the case. In a 6 to 3 decision, the majority held that Professor Scott Starson (a.k.a. Scott Jeffery Schutzman) had the right to refuse the medication.
Background
Starson was bi-polarBipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
physicist, who was regarded by his colleagues as a genius. Other physicists permitted Starson to use the title “Professor Starson” in light of his contributions to the field. Though Starson appreciated that he was not 'normal' and that he had problems dealing with people. He acknowledged that he had mental health issues, but refused to accept his condition as an illness. He also refused to consent to the course of medications that his physicians recommended for fear that it would diminish his thinking. He would have accepted psychotherapy but no medication.
The Board decided that because Starson did not recognize that he was ill and that he needed treatment, the Board decided that Starson was not able to understand the consequences of consent; he failed to appreciate the risks and the benefits and therefore he lacked the capacity to make a decision as to treatment.
Issues
Is the Board entitled to override Starson’s refusal and order him to undergo treatment?Holding: No.
Reasoning
Per Major J: According the Act, a person is able to consent when he understands the information relevant to making the decision, and can appreciate the reasonably foreseeable consequences of the decision. The role of the Board is solely to adjudicate on the issue of capacity and not to determine what is in the best interests of the patient.Prior to the Starson decision a person who does not acknowledge illness cannot accept the consequences of treatment (Khan). The court recognized that a person who has accepted the manifestations of illness, although not the final diagnosis, does not forego capacity to refuse treatment. All the patient must do is be able to:
- Able to understand the information about the treatment, and
- Able to assess the costs and benefits of the treatment.
The patient does not have to weigh the benefits properly or rationally.
The majority also noted that psychiatrists do not always agree on diagnoses (as if to devalue the importance that the court should place on their opinions). So long as the patient can recognize the symptoms, then the court will have difficulty finding incapacity.
Major accused McLachlin of doing what the Board did: of deciding what was in the patient’s best interests.
Rationale
Denial of one’s illness is not a sufficient criterion to establish a patient’s incapacity to refuse treatment.Critique
McLachlin CJ focussed on the delusions (e.g. that Pierre TrudeauPierre Trudeau
Joseph Philippe Pierre Yves Elliott Trudeau, , usually known as Pierre Trudeau or Pierre Elliott Trudeau, was the 15th Prime Minister of Canada from April 20, 1968 to June 4, 1979, and again from March 3, 1980 to June 30, 1984.Trudeau began his political career campaigning for socialist ideals,...
was killed by aliens), where Major’s majority did not.
Both McLachlin and Major agree that the issue is not a “best interests of the patient” standard.
She felt, however, that the patient may be able to understand the general nature of the illness but cannot recognize that he has the illness. This means that the patient cannot appreciate the benefits of the treatment or the need for treatment.
Commentary
The majority may have assumed too much from the following language of the Board: “it viewed with great sadness the current situation of the patient […] his life has been devastated by his mental disorderMental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
.”
The court was split on the right to self-determination and the patients’ best interests. Once you start thinking in the patients’ best interests, you become less like a lawyer and more like a psychiatrist.
According to Daphne Jarvis, a legal counsel to the Schizophrenia Society of Canada,
"The [Supreme] Court did not change the Health Care Consent Act or even make the process more difficult."
According to an article in The Ottawa Citizen,
"What the court majority ruled was that Consent and Capacity board in 1999 did not have enough evidence to support its finding that Mr. Starson was incapable of deciding on treatment."
External links
- Fighting for the right to refuse treatment: Part 1 The Ottawa Citizen, June 11, 2005.
- Fighting for the right to refuse treatment: Part 2 The Ottawa Citizen, June 11, 2005.