Legal Fallacies of Antipsychotic Drugs

posted Dec 10, 2006

Via Instapundit via Dr. Helen, a fascinating paper on anti-psychotic drugs and the difference between their perceived and real effects on cognitive functioning.

Also interesting is an unexamined assumption in the paper about what constitutes the "real you".

The conclusion of the paper reads:

Antipsychotic medications are not “mind altering drugs” as construed by legal scholars and the courts. Rather, they are beneficial treatments that uncontrovertibly improve cognition among patients afflicted with psychotic disorders, including schizophrenia. Whether the task involves making competent and informed treatment decisions, assisting defense counsel during trial, or enduring the hardships of prolonged incarceration, these medicines enhance a person’s ability to make rational decisions. There is evidence that antipsychotic medications may prevent further clinical deterioration due to potentially permanent oxidative-stress processes occurring in the brains of those affected with psychotic disorders.(163, 164) The time is ripe and the evidence overwhelming that the depreciatory attitudes towards these life-saving medicines are unwarranted and contradictory to the aims of beneficence, autonomy, dignity, and justice that medical ethics and the law passionately seek. The onus is upon the courts to make informed decisions regarding such important matters as civil commitment and competency and this necessarily entails an accurate and current understanding of questions brought before them. In terms of antipsychotic drugs, the first step is the declaration that antipsychotic medications are “mind-saving drugs”.

It should be pointed out that "cognitive functioning" here is not so much conventional intelligence, although that does play a part, but the fundamental skills that underlie intelligence, such as the ability to pay attention, filter out irrelevant sensory input, make simple plans and carry them out, etc. It's more than just intelligence, it's what connects your mind to the rest of the universe. I've never read about the cognitive function of psychotics, but I'm unsurprised to learn that it is impaired. The science doesn't support this claim, but I wouldn't even be too surprised to find out that psychosis is simply a direct result of impaired cognitive functioning; in a real way, such people aren't living in the same universe the rest of us are. (This isn't necessarily a far-out theory; I've seen theories that autism has similar causes, stemming from an inability to filter sensory input successfully.)

Thinking about it, I have to admit that I too had the unexamined assumption that anti-psychotics probably had a negative effect on cognitive function. Examining that assumption explicitly reveals that it's actually somewhat counter-intuitive; it seems unlikely that you could become "more sane" while at the same time weakening your cognitive functioning, that is, your connection to reality.

The interesting unexamined claim in the paper would read something like this: "Given the same person on two different sets of medication (potentially including 'no medication'), the one that is more legally competent and therefore more the 'real person' is the one with the highest cognitive functioning." Perhaps this claim is examined elsewhere, perhaps it is even a standard doctrine of psychology; I do not mean to make accusations, I merely observe that in this paper it is not examined. But it's the first time I've seen the idea, and I find it an interesting one.

After rolling it around a bit, my conclusion is that it probably is the best standard for such things, if you also combine it with a minimum level of cognitive functioning which you won't use drugs to go beyond. This is to prevent the attack on the standard where some hypothetical drug unnecessarily increases cognitive functioning like some kind of Focusyn, with other pontentially negative random effects the definition doesn't care about. By setting a minimum, we say we won't drug most people. (You always gotta watch those implicit infinite values in definitions, they can make you do crazy things.)


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