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Richard J Bonnie

Publications and source records attributed to Richard J Bonnie.

15 recordsLinked to original sources
PubMed2006

Judicially mandated naltrexone use by criminal offenders: a legal analysis.

The starting point for this article is the possibility of improving treatment adherence by making naltrexone therapy, particularly the recently developed depot preparation, a condition of probation or parole for nonviolent opiate-addicted offenders who voluntarily agree to these conditions. (I will characterize these arrangements as "leveraged agreements.") My assigned task is to reflect on the legal principles that would apply to these arrangements. Before addressing the legality of leveraged agreements, however, I want to consider two arrangements. First, I want to consider what I will call "no-agreement arrangements," in which a probationer or a parolee who does not want to receive naltrexone is required to do so under a threat of incarceration for noncompliance. Second, I want to consider a purely voluntary arrangement in which naltrexone treatment is not at all linked to criminal sentence. Finally, I will consider leveraged agreements.

Crime↗
PubMed2005

From coercion to contract: reframing the debate on mandated community treatment for people with mental disorders.

Approximately half the people receiving treatment in the public sector for mental disorder have experienced some form of "leverage" in which deprivations such as jail or hospitalization have been avoided, or rewards such as money or housing have been obtained, contingent on treatment adherence. We argue in this essay that framing the legal debate on mandated community treatment primarily in terms of "coercion" has become counterproductive and that the debate should be re-framed in terms of "contract." Language derived from the law of contract often yields a more accurate account of the current state of the law governing mandated community treatment, is more likely to be translated into a useful descriptive vocabulary for empirical research, and is more likely to clarify the policy issues at stake than the currently stalemated form of argumentation based on putative rights. Our hope is that adopting the language of contract may help to identify those types and features of mandated community treatment that are genuinely problematic, rather than perpetuating the unhelpful and misleading assumption that all types of leverage amount to "coercion."

Coercion↗
PubMed2005

The capacity to vote of persons with Alzheimer's disease.

OBJECTIVE: The right to vote can be abrogated when persons become incompetent to cast a ballot. This applies particularly to people with Alzheimer's disease, who at some point will lose capacity. A 2001 federal court decision offered the first clear criteria ("Doe voting capacity standard") for determining voting competence, focused on understanding the nature and effect of voting and on the ability to choose. This article explores how persons with Alzheimer's disease perform on these criteria. METHOD: The Doe standard was operationalized in a brief questionnaire, along with measures of appreciation and reasoning about voting choices. Performance was assessed in 33 patients attending an Alzheimer's disease clinic and was related to dementia severity and demographic characteristics. RESULTS: The interview questions were scored with high reliability. Performance on the Doe questions, along with appreciation and reasoning, correlated strongly with Mini-Mental State Examination (MMSE) scores. Patients with very mild to mild Alzheimer's disease generally retained adequate ability to vote, and most persons with severe Alzheimer's disease did not. Performance was highly variable among persons with moderate Alzheimer's disease. The desire to vote was a poor predictor of voting capacity. CONCLUSIONS: The capacity to vote, as embodied in the Doe voting capacity standard, can be measured simply and reliably. Structured assessment is particularly likely to be useful for people with moderate Alzheimer's disease, whose performance cannot be predicted from MMSE scores alone. This approach can ensure retention of voting rights by capable persons and exclusion of clearly impaired persons from the voting booth.

Aged↗
PubMed2004

Addressing the ethical, legal, and social issues raised by voting by persons with dementia.

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.

Civil Rights↗
PubMed2004

The American Psychiatric Association's resource document on mental retardation and capital sentencing: implementing Atkins v. Virginia.

State legislatures need guidance in implementing the United States Supreme Court's decision in Atkins v. Virginia barring execution of mentally retarded offenders. In this Resource Document, the American Psychiatric Association's Council on Psychiatry and Law, the component charged with developing policies and positions relating to forensic psychiatry, recommends statutory language addressing the definition of mental retardation, procedures relating to its assessment, and qualifications of testifying experts.

Adult↗
PubMed2002

Responsibility for addiction.

In summary, to characterize addiction as a disease is not necessarily morally incompatible with saying that addicts are responsible for yielding to it. This is admittedly a demanding approach to responsibility, but our criminal law has always set the bar pretty high. Holding addicts responsible is also strongly supported on utilitarian grounds because the threat of sanctions provides leverage to press them into treatment and to keep them engaged while therapeutic efforts are undertaken. Such a stern approach may be thought to be both unfair and unduly paternalistic. However, focusing on relapse suggests a more gentle, less jarring way of thinking about the addict's responsibility: After the period of detoxification and acute treatment, the addict is responsible for taking steps to manage the addiction. In this connection, the similarity between addiction and other chronic diseases, which lies at the heart of the brain disease claim, becomes particularly pertinent. Yes, addiction is best understood as a chronic relapsing disorder. This helps to establish realistic expectations for the benefits of treatment, but it also emphasizes the important role of behavior in disease management and points in the direction of a theory of responsibility for managing one's own illness.

Behavior, Addictive↗
PubMedDate not supplied

Mandated treatment in the community for people with mental disorders.

Commitment to community-based mental health treatment bears limited resemblance to commitment to treatment in a closed institution. It can be better understood in the context of a broad movement to apply leverage to induce treatment engagement, a movement that includes use of the social welfare and justice systems and psychiatric advance directives. Understanding "mandated community treatment" in all of its forms can be advanced by viewing it within the framework of health care quality as recently outlined by the Institute of Medicine, particularly along the dimension of patient-centeredness.

Coercion↗