Persons suffering from chronic and severe mental illnesses often refuse psychiatric treatment. This poses the question whether we as a society have any obligation toward mentally ill persons who refuse care, and, if so, the nature of this obligation and the condition(s) under which it applies.
The conclusion of this dissertation is that we, as a society, do have limited obligations toward severely mentally ill persons who refuse care. The principle of interpersonal reciprocity and an interpretation of justice based upon it form the philosophical basis of these obligations, which, however, apply only if the prospective patient is appropriately understood as "incompetent"--that is, he or she seems incapable of freely making decisions that will maintain or achieve a minimum standard of primary goods that all persons may be presumed to want (life, health, adequate nutrition, shelter, safety, clothing, etc.).
Dangerousness to self or others may be partial grounds for establishing incompetency, but the potential for dangerous actions alone is insufficient to justify involuntary psychiatric treatment if the prospective patient appears competent. If no less-restrictive alternative means are possible, the condition of incompetency alone is morally sufficient to justify the compromise of the prospective patient' s physical liberty if doing so preserves a minimum standard of well being otherwise impossible.
This interpretation of social justice, applied to the problem of the incompetent mentally ill, forms a standard and method of evaluating our social institutions--legal and medical. It is, however, inadequate to critique itself due to its parochial nature and the realization that systems of moral thought necessarily evolve in dialogue with particular cases. One theological source for critiquing our approximations of justice is the Christian notion of self-sacrificial love applied to the particular cases that this interpretation of social justice addresses. Appropriately addressing the needs of the chronic and severely mentally ill requires more than mere principles of justice, but a love that does more than justice. The hermeneutical circle of religiously-inspired love in conversation with moral philosophy and medicine will more adequately guard us against injustice than any one discipline alone can do.