Supply-side interventions such as prescription drug monitoring programs,
“pill mill” laws, and dispensing limits have done little to quell the
burgeoning opioid crisis. An increasingly popular demand-side alternative to
these measures – now adopted by 38 jurisdictions in the USA and 7 provinces
in Canada — is court-mandated involuntary commitment and treatment. In
Massachusetts, for example, Part I, Chapter 123, Section 35 of the state's
General Laws allows physicians, spouses, relatives, and police officers to
petition a court to involuntarily commit and treat a person whose alcohol or
drug abuse poses a likelihood of serious harm. This paper explores the
ethical underpinnings of this law as a case study for others. First, we
highlight the procedural and substantive standards of Section 35 and
evaluate the application of the law in practice, including the frequency
with which it has been invoked and outcomes. We then use this background to
inform an ethical critique of the law. Specifically, we argue that the
infringement of autonomy and privacy associated with involuntary
intervention under Section 35 is not currently justified on the grounds of a
lack of evidenced benefits and a risk of significant of harm. Further
ethical concerns also arise from a lack of standard of care provided under
the Section 35 pathway. Based on this analysis, we advance four
recommendations for change to mitigate these ethical shortcomings.
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