Robert Plotkin of the Mental Health Law Project called the case a “tremendous victory” for the patients’ rights movement. Alan Stone, President of the American Psychiatric Association, bemoaned it as “the most impossible, inappropriate, ill-considered judicial decision in the field of mental health law.” The case is Rogers v. Okin, and in deciding it, U.S. District Court Judge Joseph L. Tauro has gone farther than any previous court in establishing the right of hospitalized psychiatric patients to refuse medication.

The class action suit was filed in 1975 by a group of patients involuntarily committed to the Austin and May Units of the Boston State Hospital. It was brought against the Massachusetts Commissioner of Mental Health, now Dr. Robert Okin, and thirteen psychiatrists and a psychologist who were then on the staff of Boston State Hospital.

Dissatisfied with state workers' compensation laws, business interests, labor unions, state compensation bureaus, self insurers, and private insurance carriers, despite their disparate interests, increasingly agree that such laws are in need of significant revision. But the call for reform has been heard before. In 1972, the National Commission on State Workmen's Compensation Laws (hereinafter referred to as the National Commission) reported to the President and Congress that “… the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable.”

Between 1972 and 1977 hundreds of state laws were enacted in response to the recommendations of the National Commission and the threat of federalization. Yet, in its 1977 report to the President and Congress, the Policy Group of the Interdepartmental Workers' Compensation Task Force concluded:

Today's practicing physicians and attorneys can be assured of increasing contact with the legal and insurance issues stemming from the adverse consequences of a patient's injuries or illnesses. Mounting litigation involving alleged medical negligence as a cause of personal injury, and expanding social legislation and insurance programs which provide benefits to injured or disabled persons, their dependents, or their beneficiaries has required an increase in the medical problem issues encountered in processing and resolving contested claims. Evaluations of such claimants by physicians are essential to the proper handling of their legal and insurance claims.

Medical evaluations performed specifically to provide information to the legal system and the expression of medical opinions formed after such evaluations constitute an area of medicine best termed Forensic Medicine. The traditional concept of “forensic medicine” was limited almost entirely to the medical investigation of the causes of death and the results of trauma, injury, and violent crimes. Forensic medicine practitioners were generally restricted to pathologists who performed medicolegal autopsies.

A new and potentially important decision is expected from the Massachusetts Supreme Judicial Court on the issue of withdrawing life-sustaining medical treatment from those unavailable to decide for themselves. The case of Earle Spring is but an example of an increasingly familiar situation: individuals who are not totally “incompetent,” and for whom there is a poor, dismal, and certain prognosis. The lives of hundreds of patients may depend upon being hooked up to life-sustaining or life-prolonging examples of medical technology, and some will indicate that they do not want such procedures to continue.

A right to refuse medical treatment is generally accepted and patients are. presumably, able to exercise this right and instruct their physicians to stop rendering medical care even if death is the clear result.