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Forced medication is illegal and unlawful

TREATMENT REGIME / The effects of antipsychotics have been based on hope and unfounded claims, illustrated not least by constantly new medications and doses.


I have shown in several articles in recent years – including in the Journal of the Norwegian Medical Association 2017 – that Norwegian compulsory drug practice is illegal and human rights unlawful. The law has since the beginning of the 1980 years provided as conditions for compulsory medication that this "with a high probability" will result in healing or significant improvement or prevent significant deterioration. The condition, of course, follows from the need to avoid malpractice and is also justified by the reason for avoiding the violation of the torture prohibition in the European Convention on Human Rights. 3. This requires that before such treatment is started, such effects are very likely to be foreseen.

Studies on the knowledge base for antipsychotics, presented in NOW 2011: 9 Paulsrud Committee report, showed that the effects of group-level antipsychotics – in which only one in five patients achieve a positive effect – are too low to predict significant improvement for the individual patient. The practice has, ever since the condition was introduced, been based on hope and unfounded claims, illustrated not least by a treatment regimen that is trying itself with ever-new drugs and doses.

I have also emphasized in articles that the County Governor as the appellate body for decisions on compulsory medication is a purely sand-spraying body.

Civil Ombudsman's statements

In two decisions, made on December 18, 2018 and January 21, 2019, the Civil Ombudsman stated that the practice is illegal. The statements relate to the rejection of complaints made by County Governor of Aust- and Vest-Agder (FmAV) and the County Governor of Oslo and Akershus (FmOA).

The county governor's view of the law was obviously untenable, and the decisions on coercive medication illegal.

The Civil Ombudsman states that the requirement of "high probability" means something different and more than an ordinary probability overweight for sufficient positive effect. The requirement relates to the individual patient. However, the Mental Health Act does not provide for "trying" or "trying out" compulsory medication if the requirement of "high probability" is not met. The obligation to state that the condition is fulfilled is very strict and refers not only to the individual patient, but also to the individual drug the compulsory decision applies. The decision must show what justifies that this particular drug "in all likelihood" will have a sufficiently positive effect on this particular patient.

The county people apparently seemed to have had different understandings of the condition "great probability". The county governor of Aust- and Vest-Agder, albeit somewhat unclear, seemed to have the same opinion as the ombudsman. The county governor of Oslo and Akershus, on the other hand, felt that there was not even a requirement of 50 per cent probability, an opinion the Ombudsman obviously found unsustainable.

In reality, the explanation for this is that both county governors were aware of the content of the law, but that the county governor in Oslo and Akershus made a kind of attempt to interpret the terms of the law to a certain extent allowing for the soon-to-be 40-year practice of the condition. . In reality, the county governors, like the decision-makers, have probably deliberately failed to comply with the terms of the law. For the County Governor of Aust- and Vest-Agder, this is illustrated by the fact that it was impossible to comply with the Ombudsman's repeated requests to prove which professional knowledge base indicated that it was very likely to predict sufficient positive effect of the compulsory medication. Instead, the county governor questioned the basis for the Ombudsman's involvement in professional assessments. The Ombudsman responded laconically that it was his primary task to ensure compliance with the law.

In the case FmOA, the Civil Ombudsman concluded that the County Governor's view of the law was obviously unsustainable and the decisions on compulsory medication illegal. In the case FmAV, he concluded that there were justified doubts as to whether the requirements of the law were fulfilled, but that the obligation to state reasons was not in any circumstances.

These are mass violations of the law.

Based on the Paulsrud Committee's investigations in 2011, the Ombudsman stated that "the accuracy of use of antipsychotics is uncertain and low, both in emergency treatment and – especially – in maintenance treatment". The Ombudsman did not decide whether the knowledge base – on a general basis – is suitable to satisfy the requirement of high probability at first reading. In fact, the general knowledge base is precisely not capable of predicting that the patient is very likely to achieve the qualified positive effect of this drug.

Consequences of the decisions

It is clear that the two cases are only concrete manifestations of a general practice that applies to both compulsory drug decisions and the county governors' decisions in appeals. The FmOA then explicitly states that if "high probability" requires 50 percent probability or more, "this could mean significant changes in treatment practices". The Civil Ombudsman comments implicitly: "If this is true, such an illegal practice gives serious cause for concern." That it is unquestionable.

The illegal practice has been going on for at least the decades since the condition of "great probability" was introduced into the law. The decision makers in psychiatry have never had reason to believe that a sufficiently positive effect could be predicted with great probability. And since the Paulsrud Committee presented its report in 2011, neither county governors nor health authorities have been unaware of the practice. That they have not cared about the illegalities, which have harmed far more than those who may have profited, is abhorrent. This can only be understood in light of the fact that this patient group does not have strong spokespersons and does not interest the public or the media significantly, and therefore not the politicians.

Of course, the authorities must take immediate steps to put an end to the practice. Equally, of course, the victims are compensated for the illegalities. In this context, it is of interest that the Civil Ombudsman in the FmOA case asks the County Governor "to consider how the wrong done to the complainant can be remedied". Since there are mass violations of the law, it will be necessary to appoint a committee tasked with mapping the extent of the illegal decisions made over the years and assessing how patients should be compensated for the abuses.

In the wake of the statements, a recommendation has been drawn up for the Government and the Storting, which has been organized for a signature campaign at (the International Legal Commission's Norwegian branch). See ICJ Norge Lund's post in the Journal of the Norwegian Medical Association

Civil Ombudsman 18.12.2018 Forced Medication, County Governor of Aust- og Vestagder's decision

Civil Ombudsman 21.1.2019 Forced Medicine, County Governor of Oslo and Akershus
Lund is a former Supreme Court judge and chair of the Lund committee. Today a member of Ny Tid's editorial board.

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