When assessing someone for a detox protocol, clinicians understand that the person has the right to fully participate in the choice of the level of care, such that it does not interfere with their civil rights or freedom to participate in other aspects of their lives (if they are able to make such a decision). This is referred to as the principle of least restrictive care. There are four aspects regarding least restrictive care:
- Clients should be treated in settings that interfere least with their civil rights and freedom to participate in other aspects of society.
- Clients are allowed to disagree with the recommendations for their care and have the right to refuse any or all care.
- Clients should be informed in all aspects of their treatment and treatment planning.
- For individuals unable to make decisions or act in their own self-interest, the treatment program needs to carefully consider all state, federal, and agency policies and statutes when developing a plan of care.
The statues regarding forced admission into a treatment program vary from state to state. The team members need to consider all aspects of the situation before forcibly admitting someone into a treatment program. There is always some debate regarding exactly what the aspects of least restrictive care really mean and how to interpret them under specific circumstances. Generally, treatment providers are required to defer to the client in decisions regarding all aspects of that client’s care. Nonetheless, it is quite clear that there are many instances in an acute care admission where the individual is not acting in their own best interest and not making an informed decision. These instances need to be weighed carefully, and there are various protocols that can be used to determine if someone is able to make informed choices.
Certainly, an individual who is suicidal, severely intoxicated to the point of being unable to understand the situation, or in an emergency life-threatening medical state due to level of intoxication will be admitted to the highest level of care available. In many cases, an individual’s ability to make an informed choice may wax and wane. In cases of drug intoxication or severe emotional stress (such as being suicidal), once the acute situation is resolved, the person’s ability to make an informed choice may be restored. Once an individual is deemed to be able to make informed decisions, the person has the right to fully participate in the treatment process. In situations where individuals are deemed to continually be unable to make informed decisions due to psychological disorders or cognitive impairment, treatment providers can rely on relatives or close friends (in some situations) to assist the person or the treatment team in making decisions that are in that person’s best interest. Of course, there are some instances where formal legal intervention is necessary and where court orders will eventually dictate who can or cannot make decisions for the individual.