Role of Subjectivity when Determining the Least Restrictive Alternative in Compulsory Treatment for Mental Illness

This study considers application of the least restrictive alternative in the context of determining the legitimacy of compulsory treatment for mental illness. This principle has an important role to play when deciding between different treatment options. When applying this test, arguably a purely objective valuation of restrictiveness should be avoided, and significant weight should be given to what the patient considers subjectively to be more or less restrictive. Examples are provided on how to apply this principle in treatment decisions, including the authorisation of electroconvulsive therapy. Adopting a subjective test of what is least restrictive complies with current good medical practice, and does not require a change of law. It is important for this principle to be clarified and emphasised in the context of compulsory treatment for mental illness, where civil and human rights are concerned, and the importance of patient autonomy can be overlooked.