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Civil Commitment: Recognition of Patients’ Right to Treatment, Donaldson V Washington University Law Review Volume 1974 Issue 4 January 1974 Civil Commitment: Recognition of Patients’ Right to Treatment, Donaldson v. O’Connor, 493 F.2d 507 (5th Cir. 1974) Follow this and additional works at: https://openscholarship.wustl.edu/law_lawreview Part of the Health Law and Policy Commons, and the Law and Psychology Commons Recommended Citation Civil Commitment: Recognition of Patients’ Right to Treatment, Donaldson v. O’Connor, 493 F.2d 507 (5th Cir. 1974), 1974 WASH. U. L. Q. 787 (1974). Available at: https://openscholarship.wustl.edu/law_lawreview/vol1974/iss4/8 This Case Comment is brought to you for free and open access by the Law School at Washington University Open Scholarship. It has been accepted for inclusion in Washington University Law Review by an authorized administrator of Washington University Open Scholarship. For more information, please contact [email protected]. CIVIL COMMITMENT: RECOGNITION OF PATIENTS! RIGHT TO TREATMENT Donaldson v. O'Connor,493 F.2d 507 (5th Cir. 1974) Plaintiff was involuntarily civilly committed to the Florida State Men- tal Hospital in 1957.1 Before his release in 1971, he brought an action under 42 U.S.C. § 1983,2 alleging that five hospital and health officials deprived him of adequate psychiatric treatment. 3 A jury awarded com- pensatory and punitive damages against two physicians,4 and they ap- pealed. The United States Court of Appeals for the Fifth Circuit af- firmed and held: A nondangerous involuntarily committed mental pa- tient has a constitutional right to treatment. 5 1. Kenneth Donaldson was committed by a county court judge of Pinellas County, Florida, pursuant to Act of Aug. 1, 1955, ch. 29909, § 2, [1955] Fla. Laws 827 (now FLA. STAT. ANN. § 394.467 (Supp. 1974)). He was diagnosed as suffering from "para- noid schizophrenia," which is characterized primarily by the presence of persecutory or grandiose delusions, often associated with hallucinations. Excessive religiosity is sometimes seen. The patient's attitude is frequently hostile and aggressive, and his behavior tends to be consistent with his delusions. AMRIcAN PsYcmATmc ASSOCIATION, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DIsoRDERs § 295.3 (2d ed. 1968). 2. 42 U.S.C. § 1983 (1970) provides: Every person who, under color of any statute, ordinance, regulation, cus- tom, or usage, of any State or Territory, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction there- of to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress. 3. Donaldson v. O'Connor, 493 F.2d 507, 510 (5th Cir. 1974), cert. granted, 43 U.S.L.W. 3239 (U.S. Oct. 21, 1974) (No. 8). Donaldson had previously brought fifteen unsuccessful petitions for a writ of habeas corpus in the state and lower federal courts in Florida. Petitioner's Brief for Certiorari at 10, O'Connor v. Donaldson, 43 U.S.LW. 3239 (U.S. Oct. 21, 1974) (No. 8). On four occasions, he had unsuccess- fully petitioned the Supreme Court of the United States. Donaldson v. O'Connor, 400 U.S. 869 (1970) (writ of certiorari); Donaldson v. O'Connor, 390 U.S. 971 (1968) (writ of certiorari); Donaldson v. Florida, 371 U.S. 806 (1962) (habeas corpus); In re Donaldson, 364 U.S. 808 (1960) (leave to file petition for writ of habeas corpus). 4. The judgment was against two physicians who were hospital administrators and Donaldson's attending physicians from 1957 to 1971. Compensatory damages were lev- ied in the amounts of $17,000 and $11,500, and punitive damages were assessed at $5,000 per doctor. 5. Donaldson v. O'Connor, 493 F.2d 507, 527 (5th Cir. 1974), cert. granted, 43 U.S.L.W. 3239 (U.S. Oct. 21, 1974) (No. 8). Washington University Open Scholarship 788 WASHINGTON UNIVERSITY LAW QUARTERLY [Vol. 1974:787 Though statutory language varies,0 most states rely on two basic justi- fications for permitting the involuntary commitment7 of the mentally ill-8 First, for the benefit and protection of society, the state may act under its police power to confine those found to be dangerous." Sec- ondly, under the parens patriae doctrine, the state may choose to com- mit a person for his own benefit.10 Inherent in both rationales is the 6. Developments in the Law-Civil Commitment of the Mentally I1, 87 HARV. L. REv. 1190, 1203-04 (1974) (footnotes omitted) [hereinafter cited as Civil Commitment]: The primary differences among the present state standards for involuntary commitment are contained in the statutory language setting forth the requisite impact or consequences of the mental illness. Fifteen jurisdictions authorize commitment only if the individual is mentally ill and dangerous to himself or others or is unable to care for his physical needs. Fourteen other states pro- vide for commitment if the mentally ill person is dangerous or is in need of care or treatment, with twelve of these requiring that the person in need lack the capacity to make a responsible treatment decision. Seven states require that commitment be necessary to protect the welfare of the individual or the welfare of others, and fifteen others allow compulsory hospitalization based on a mental illness which renders the individual in need of care and treatment or a fit subject for hospitalization. For a listing of the statutory language in the various states see id. at 1203-04 nn.11- 14. 7. See generally Bimbaum, A Rationale for the Right, 57 GEo. L.J. 752 (1969) [hereinafter cited as Birnbaum]; Goodman, Right to Treatment: The Responsibility of the Courts, 57 GEo. L.J 680 (1969); Katz, The Right to Treatment-An Enchanting Legal Fiction?, 36 U. Cm. L. Rlv. 755 (1969); Civil Commitment 1207-40. 8. See Livermore, Malmquist & Meehl, On Justifications for Civil Commitment, 117 U. PA. L. REv. 75, 80 (1968): Obviously, the definition of mental illness is left largely to the user and is dependent upon the norms of adjustment that he employs. Usually the use of the phrase "mental illness" effectively masks the actual norms being ap- plied. And, because of the unavoidable ambiguous generalities in which the American Psychiatric Association describes its diagnostic categories, the di- agnostician has the ability to shoehorn into the mentally diseased class almost any person he wishes, for whatever reason, to put there. 9. Institutionalization under the police power concept is viewed as a form of pre- ventive detention of the mentally il individual who is dangerous to society or to himself. The current trend seems to be toward restricting the class of mental illnesses considered dangerous and increasing the degree of probable harm needed to support a finding of dangerousness. Civil Commitment 1205; see Jackson v. Indiana, 406 U.S. 715 (1972); Lessard v. Schmidt, 349 F. Supp. 1078 (E.D. Wis. 1972), vacated on other grounds, 414 U.S. 473 (1973). But see Ehagen v. Miller, 29 N.Y.2d 348, 278 N.E.2d 615, 328 N.Y.S. 2d 393, cert. denied, 409 U.S. 845 (1972). Although dangerousness is usually the standard for police power commitments, studies reveal that mental illness is a poor indicator of future dangerous conduct. Comment, Wyatt v. Stickney and the Right of Civilly Committed Mental Patients to Adequate Treatment, 86 HARV. L. Rv. 1282, 1289-90 n.43, 1295 (1973); see Bimbaum 767 (facts do not support laymen's picture of the mentally ill as universally homicidal or suicidal). 10. Largely because of the uneasiness with the dangerousness standard, see note 9 supra, the therapeutic intent of involuntary commitment under parens patrlae has been https://openscholarship.wustl.edu/law_lawreview/vol1974/iss4/8 Vol. 1974:787] PATIENTS' RIGHT TO TREATMENT 789 nonpunitive nature of the confinement, the purpose being to "treat,"'1 "cure,'' 2or "rehabilitate.' '13 Although recognition by the legal system of a right to treatment14 follows logically from the nonpenal motives underlying the commitment statutes 5 and the deprivations of a committed individual's freedoms,' 6 the courts have refused to deal precisely with what is meant by "treat- ment." ' Nevertheless, the states' purported purpose, to treat, is con- increasingly emphasized. Katz, supra note 7, at 759. Parens patriae is translated as "father of his country" and refers to the state's power of guardianship over persons with disabilities. To commit a person under the rationale of parens patriae, recent cases maintain that the individual must be shown to lack the capacity to make treatment de- cisions. See, e.g., Winters v. Miller, 446 F.2d 65 (2d Cir.), cert. denied, 404 U.S. 985 (1971); Lessard v. Schmidt, 349 F. Supp. 1078 (ED. Wis. 1972), vacated on other grounds, 414 U.S. 473 (1973). 11. Stachulak v. Coughlin, 364 F. Supp. 686, 687 (N.D. Ill. 1973). 12. Wyatt v. Stickney, 325 F. Supp. 781, 784 (M.D. Ala. 1971). 13. In re Ballay, 482 F.2d 648, 658-59 (D.C. Cir. 1973) (dictum). 14. Dr. Morton Birnbaum is usually credited as being the first to solicit the courts' recognition of the right to treatment. As he originally conceived it, the concept was to entail releasing all mental patients, dangerous or not, who were not receiving proper medical treatment. The hope was that, if such a course were taken, new and adequate treatment facilities would result from the public's awareness and concern. See Birn- baum, The Right to Treatment, 46 A.B.A.J. 499 (1960); Kittrie, Can thre Right to Treat- ment Remedy the Ills of the Judicial Process?, 57 GEo.
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