Self-determination is greatly valued in Australasian society. The primacy given to an individual's autonomy is reflected both in various ethical codes (Australian Psychological Society, 2007; New Zealand Psychological Society, 2012) and in law as it applies to psychological treatment.
Generally, individuals should not be provided treatment unless they are adequately informed of its risks, its benefits, and the alternatives available to them. Individuals then freely agree to the treatment offered. If a psychologist failed to gain valid consent in this way, and some injury to the client were to result, the psychologist could be open to a claim of negligence (Kerridge, Lowe, & Stewart, 2013). Additionally, it is generally unlawful to restrict the movement of, or even touch, another person without his or her consent.
In most cases, as long as adults are able to understand the information relevant to a treatment choice, and are able to adequately consider that information, they cannot be forced to have treatment they refuse (Ryan, Callaghan, & Peisah, 2015). This is true even if their refusal will result in their own serious injury or death. This is why, for example, people of the Jehovah's Witness faith can successfully refuse certain medical procedures.
There are circumstances, however, where the law permits treatment without consent. Some of these circumstances relate to psychological conditions. The laws and ethical considerations that apply in these circumstances are the subject of this chapter.
Compulsory treatment of severe psychiatric illness
Each jurisdiction in Australia and New Zealand (NZ) has a mental health Act that sets down conditions under which a person with a serious mental illness may be detained and treated without consent. In the Acts, the definitions of mental illness are described in terms of various symptoms (e.g., delusions, serious disturbance of mood, irrationality). The exact definitions vary between jurisdictions but all are designed to capture not only severe depression, mania, and schizophrenia, but also people temporarily overcome with emotional turmoil, such as might occur in extreme grief.
As outlined so far, general medical treatment cannot be given to an adult unless the adult has lost the ability to understand and weigh the information relevant to the decision.