Regardless of their mental condition, Alzheimer patients may still be liable for any civil wrongs committed. In the event that an individual with Alzheimer’s has an automobile accident, for example, the owner of the car and the patient could be liable for damages. If the family lives in an apartment and the patient lets a sink overflow and water damages adjoining apartments, both the patient and family may be jointly responsible for the necessary repairs to the other domiciles. The family should give serious consideration to limiting the freedom of an Alzheimer patient when, because of the disease, the risks he poses to himself or others are considerable.When an Alzheimer’s diagnosis is confirmed, the family should include among its various considerations a review of insurance policies to be certain that problems directly traceable to the disease are covered. This review should include both policies covering the home and any automobiles on the premises. Generally, homeowner’s insurance provides the most comprehensive type of coverage. An insurance agent familiar with the problems posed by Alzheimer patients would be a good resource for such a review. An Alzheimer support group could also provide the names of a people who might be knowledgeable in this area.

The author’s parents recently were in a restaurant in the small town in north Georgia where they live. As dessert came, two men approached his parent’s table. The elder of the two, always the Southern gentleman and ever gracious, complimented his mother on the way she was dressed, then turned to his father and said, “Now I want you to be sure and come by the office tomorrow and sign those papers. We’ve got to get them to court. ”

Such an interchange could occur anywhere. What is important about this event is that the man in question was an attorney by training but had not practiced law for at least ten years and had no business dealings with the author, father for even longer.

The man was successful, being both diligent and smart in his dealings with the courts and clients. However, as he approached his retirement years he became neglectful of his personal appearance and some of his business dealings. He had struggled with alcohol abuse early in his life and had overcome this problem with the help of his law partners. When these new problems of attention to his personal care, business, and social relationships became evident, those who cared for him actively sought to resolve them. He was fortunate that he had business partners who would protect him from the consequences of neglect of important matters and a family who would intervene when needed. As his problems with memory progressed he gave up the practice of law, turned the care of his various business interests to others, and concentrated his efforts on the tasks of retirement. Because of his children’s knowledge and timely intervention, this was a success story for him and his family. However, without thoughtful care, planning, and a willingness to intervene by concerned family members the outcome could have been disastrous.

J. Ray Hays provides an overview of the legal issues that Alzheimer families need to be aware of to ensure that careful planning can be made well in advance of the need for legal intervention. Families facing the difficulties of dealing with a relative who has Alzheimer’s disease need to be aware of the protection and assistance they can obtain from the courts. Families with specific legal problems should consult an attorney who deals with such issues. Elder law, wills, estates, and trusts are an emerging specialty in the law, and a family who takes the time to find competent assistance will be rewarded.

The family of an Alzheimer patient may pursue involuntary commitment to a state institution when the patient’s behavior has become so disordered or disruptive that it becomes intolerable or unmanageable. Some nursing homes are unwilling to accept a patient who poses severe behavior problems and demonstrates a significant lack of personal care, as is sometimes the case with Alzheimer patients. For these reasons family members may want to consider the commitment process.Each state has some provision for the involuntary commitment of individuals who are mentally disturbed. In most areas of the country community mental health centers provide families with advice regarding commitment procedures. In larger communities there are specialized courts and court personnel who deal exclusively with such problems. The local mental health association is generally a good source of information on such matters.

There are generally three requirements that must be met before an individual may be involuntarily committed, although these requirements may vary from state to state -

(1) The individual must be determined to have a mental disorder

(2) He or she must require hospitalization (for example, the patient cannot manage in a less restrictive environment)

(3) The person is a danger to himself or others.

There must be at least clear and convincing evidence of these three requirements, generally based on recent overt acts, before an individual may be committed.

During the 1970s there were several landmark judicial decisions related to the return of mentally impaired individuals to community facilities. These decisions dealt with the right to refuse treatment, the right to less restrictive alternatives to institutionalization, and the right to treatment.

Right to Treatment

Once an individual has been hospitalized, what must occur? What is the obligation of the state to provide treatment? The U.S. Supreme Court, in its decision of Donaldson v. O’Connor, stated that the right of society to involuntarily hospitalize a person who is not dangerous is based on a quid pro quo. The right to hospitalize rests on a responsibility to provide treatment. In Donaldson’s fourteen years of hospitalization the court noted that all he received was “milieu therapy,” which, in his case, consisted of sitting in a room filled with other persons who were deemed mentally ill. Without more evidence that treatment was being provided, the Supreme Court declared Donaldson was unjustly hospitalized and ordered his release. The basic premise of this case is that a patient who is hospitalized must be treated or released provided they represent no danger to them ­ selves or others.

Right to Refuse Treatment

Once a patient has been hospitalized, what is the right of the patient to refuse treatment? The United States District Court of New Jersey, in the case of Rennie v. Klein, set a precedent for determining the conditions under which a psychiatric inpatient has the right to refuse treatment. John Rennie was an involuntary mental patient who, at the time of the hearing, had been admitted to psychiatric hospitals twelve times. Although involuntarily committed, he had never been declared incompetent. Rennie brought a civil action against the hospital staff to prohibit them from administering drugs to him by force in the absence of any emergency. However, the court delineated four factors that must be considered in determining whether an injunction should be issued when a patient refuses medication.

These factors are -

(1) The patient’s capacity to decide on his particular treatment

(2) The patient’s physical threat to other patients and to staff at the institution

(3) Whether any less restrictive treatments exist

(4) The risk of permanent side effects from the proposed treatment.

The court held that an involuntary mental patient has a right to refuse medication in the absence of an emergency, as a legitimate exercise of his constitutional right to privacy. In the absence of an emergency, some due process hearing is required prior to forced administration of drugs. This decision, by enumerating the factors to be considered in cases when patients refuse treatment, reflects strides by the court toward establishing further civil liberties for involuntary mental patients. This is not a national standard, however, and a clear statement on refusal of treatment remains to be given by the Supreme Court. There is little doubt that the growth of civil liberties in this sphere will continue. The day may come when persons suspected of mental ill­ness will have the same procedural and substantive protection as those accused of committing a crime.

Families who are considering having their Alzheimer relative committed should consider that state hospitals no longer warehouse patients. There is a duty to provide treatment to the extent that it can be provided. Consideration is also given to removing from state hospitals patients who do not need intensive types of care; such patients are placed in less restrictive environments. Many Alzheimer patients require an intermediate level of care that may be more efficiently provided in such less restrictive environments as nursing homes. Moving patients into the less restrictive alternative is the sensible course of action for the patients, the staff of institutions, and family members.