Am I Really Free?

Four years ago, twenty six year old Kerrie Wooltorton drank antifreeze with the intention of ending her life. She'd already been admitted to hospital several times following previous attempts. But this time, there was a notable difference.

Kerrie handed medical staff a note she'd written, asking them to keep her comfortable but to let her die. The treating team noted the clarity of her communication and instructions, and concluded that she had the ability or 'capacity' to refuse life-saving treatment. They felt they had no alternative but to let her die.

Although the inquest into Kerrie's death concluded that she had the capacity to refuse life-saving treatment, her family disagreed - how could a young woman, who had made several attempts on her life, be capable of making a decision that would ultimately lead to her death?

This case highlights a pressing issue in mental health circles today - when is a person with certain disorders of the mind or brain, including some who are being detained under the mental act, free to decide for themselves, and when does that disorder constrain their freedom?

For many years, the health service has recognised a patient's right to consent to or refuse treatment for physical disorders. But with the arrival of the Mental Capacity Act in 2007, which places the prized concept of patient autonomy at the very heart of medical decision making, consideration of patient rights are now extending more overtly into the mental health setting.

Mental health professionals are starting to face questions about whether some patients' expressed wishes can genuinely be said to be their own.

It's also taxing the minds of philosophers and lawyers, who are working with psychiatrists, interviewing patients with a range of mental health disorders, to shed light on when people are free decide, and when they are not.

When are mentally ill patients really free to make decisions about their treatment?