Too Sick To Treat, Per Regulation
These regulations require that treatment must be predicated on informed consent, which is when “the recipient or his or her guardian possesses capacity to make a reasoned decision regarding the treatment and/or services and the recipient or his or her guardian is provided with adequate information concerning the treatment and/or services.”
“Capacity” is defined as “sufficient understanding to comprehend the information [provided on the proposed treatment] and to make a responsible decision concerning a particular treatment and/or service.”
A large portion of those with the most acute psychiatric conditions are affected by anosognosia, a physiological symptom that can render them incapable of comprehending that they are sick. Virtually de facto, such a person would no have capacity and be incapable of informed consent absent a guardian.
The regulations require the initial determination of incapacity be by a qualified mental health professional and confirmed by a physician or clinical psychologist. Once the incapability of informed consent is established, notice must be sent to the rights protection and advocacy agency of the Maine mental health system, the head of the mental health facility and, if the patient does not object, the recipient's next of kin.
At that point the mental health professional recommending the treatment and a representative of the treatment team must meet with the recipient to essentially solicit reconsideration and explore alternatives.
And should that prove unsuccessful, the concluding line of the pertinent section of regulations is explicit: “The head of the program may conclude that the recipient's termination from services is the only available option.” No other alternatives are delineated.
Once carefully determining and documenting that the person is so sick as to be incapable of making treatment decisions, the state encourages closing off the possibility of care in the future.