Re "Tragedy follows landmark court win," March 16
The judges who ruled that Kanuri Qawi could refuse treatment displayed the power of stigma. Courts have been reluctant to unplug life-support systems until they have medical evidence that a comatose patient has no chance of survival. Has any court made it impossible to obtain treatment for a person who is unconscious from a heart attack or in a diabetic coma?
Clearly, there is a double standard when only those with brain diseases are being given a choice to refuse medication during a medical crisis. People who have impaired brain functioning are as human, as important and as worthy of care in a crisis as those with other diseases.
When the court denies medical care to a whole class of people, it is stigma.
JOY M. DOYLE
In regard to the legal dilemma of involuntarily medicating the mentally ill, I have more hope for a scientific solution than a legal one. Currently, doctors don't know why one medication works for one person and not another. If you break your arm, every doctor will agree on what to do. However, for medications for mental illness, the psychiatrist is basically making an educated guess about which medications to try. It takes several weeks to rule out a medication, and searching for the right combination can go on for several months or even years.
Perhaps soon, some genius doctor will figure out how to use brain scans to determine what drug is most likely to work for a specific brain. This would change everything by dramatically reducing the frequency and duration of involuntary hospitalization, and the current dilemma would be rendered moot.
FRANK C. BARON
Re "A profound but controversial effect," March 16
The term "refusing" has become overly comfortable and so widespread in reporting on mental health that it is seldom noticed. "Declining" is accurate -- one declines a particular treatment. One can only refuse if force has already entered the picture or if one misinterprets the metaphor "doctor's orders" as military orders. One has the right to decline doctors' treatment suggestions. We do not live in a Mengelian world.
HAROLD A. MAIO
\o7Fort Myers, Fla.
\f7\o7The writer, a former consulting editor of the Psychiatric Rehabilitation Journal, is a language consultant with the University of Pennsylvania Collaborative on Community Integration of Individuals with Psychiatric Disabilities.