Find Legal Information

Docket No. 92777-Agenda 18-September 2002.

In re MARY ANN P. (The People of the State of Illinois,
Appellant, v. Mary Ann P., Appellee).

Opinion filed November 21, 2002.

JUSTICE FITZGERALD delivered the opinion of the court:

This appeal concerns the operation of section 2-107.1 of theMental Health and Developmental Disabilities Code (Code) (405ILCS 5/1-100 et seq. (West 2000)). Section 2-107.1 permits thecircuit court, upon the filing of a petition and following anevidentiary hearing, to enter an order authorizing theadministration of involuntary treatment to a recipient of mentalhealth services. The involuntary treatment involved in this case isthe administration of psychotropic medication. The issue weconsider is whether section 2-107.1 requires the use of a specialverdict form, so that the jury may "selectively authorize" theinvoluntary administration of only those medications it deemsappropriate. For the reasons discussed below, we conclude thatsection 2-107.1 does not permit selective authorization ofpsychotropic medication. Accordingly, we reverse the judgment ofthe appellate court and affirm the judgment of the trial court.

BACKGROUND

On March 13, 2000, the State filed a petition in the circuitcourt of Kane County, pursuant to section 2-107.1 of the Code,seeking an order authorizing the involuntary administration ofpsychotropic medication to respondent, Mary Ann P., for a periodof 90 days. The petition was signed by Dr. Donna Luchetta,respondent's treating psychiatrist at the Elgin Mental HealthCenter (EMHC) from December 1998 to June 2000. The petitionlisted six medications: Zeprexa, Orap, Haldol, Haldol decanoate,Cogentin, and Ativan. On the preprinted petition form, Zeprexawas listed as the "1st choice," and the other five medications werelisted as "Alternatives." The petition also identified a dosage rangefor each drug and the tests and procedures necessary foradministration of the drugs.

At the hearing on the State's petition, Dr. Luchetta testifiedthat respondent had been transferred from Northwest CommunityHospital to the EMHC on December 28, 1998, and involuntarilyadmitted on the petition of her mother. This was not the first timerespondent had been admitted to the EMHC. According to Dr.Luchetta, respondent suffers from paranoid schizophrenia, apsychotic disorder marked by paranoid and somatic delusions,disorganized thought processes, and impaired social andoccupational functioning. Dr. Luchetta described respondent'sdelusions and the ways in which her ability to function haddeteriorated.

Dr. Luchetta further testified that, beginning in July or August1999, as the result of a prior court proceeding, respondent wasinvoluntarily administered psychotropic medication. Prolixin wasinitially administered but was discontinued after it causedparkinsonism, a temporary syndrome characterized by symptomssimilar to those associated with Parkinson's disease. In late August1999, Zeprexa was administered, which lessened respondent'sdelusions. In September 1999, Orap was also administered, whichsignificantly diminished respondent's delusions. While medicated,and for a short time afterwards, respondent was pleasant,appropriate, and well-engaged. Respondent was able to participatesuccessfully in EMHC workshops. She was no longer agitated,hostile, intrusive, or argumentative. Respondent told Dr. Luchettathat she felt better. Toward the end of the involuntary medicationperiod in October 1999, respondent told Dr. Luchetta that shewould like a trial period without medication. Subsequently, inNovember 1999, her medications were tapered off. On severaloccasions thereafter, Dr. Luchetta recommended that respondentresume medication. Respondent refused every treatmentrecommendation, and by March 2000 she was again psychotic anddelusional. At the time of the hearing, respondent was unable towork and provide for her own basic needs.

Dr. Luchetta testified at length about the benefits and potentialside effects of each medication listed in the petition. Dr. Luchettastated that Zeprexa was her "first choice" in medication. Sheexplained that Zeprexa is a relatively new atypical antipsychoticdrug that resolves psychosis by changing the balance of naturalsubstances in the nervous system, particularly dopamine. Possibleside effects include weight gain, constipation, dry mouth,hypotension, and a movement disorder known as tardivedyskinesia. Dr. Luchetta's second medication choice was Orap.Although Orap is prescribed primarily for the treatment ofTourette's Syndrome or tic disorders, it also resolves psychosis bydecreasing the amount of dopamine in the system. Orap can alsoinduce tardive dyskinesia. Dr. Luchetta testified that, during theperiod in 1999 when respondent was being treated with Zeprexaand Orap, she experienced minimal side effects and did not exhibitany signs of tardive dyskinesia.

The next two medications listed in the petition were Haldol,a typical antipsychotic medication, and Haldol decanoate, theinjectable form of Haldol. Dr. Luchetta testified that Haldoldecanoate can last up to four weeks in the patient's system and isbeneficial in cases where the patient is unwilling to takemedication on a daily basis. Haldol can produce significant sideeffects, including tardive dyskinesia, which occurs inapproximately one of 100 patients, and neuroleptic malignantsyndrome, a condition that adversely affects regulation of aperson's body temperature and occurs in approximately one of1,000 patients. Haldol can also produce parkinsonism andextrapyramidal side affects, i.e., acute muscle contracture. Dr.Luchetta stated that the drug Cogentin, also listed in the petition,blocks some of these extrapyramidal side effects. The mostcommon side effect of Cogentin is blurred vision, a condition thatcan be monitored.

The final medication listed in the petition was Ativan, a mildtranquilizer. Dr. Luchetta testified that administration of a smallamount of Ativan can greatly reduce the dosages of antipsychoticmedications administered and, in turn, prevent many of the sideeffects. The antianxiety effects of Ativan, which is available ininjectable form, also help persuade an otherwise unwilling patientto take medications, such as Zeprexa and Orap, which are in tabletor liquid form.

In addition, Dr. Luchetta testified that the side effects of anymedication can be monitored through observation and testing,including a complete blood count, a thyroid function test,urinalysis, a comprehensive metabolic profile, and anelectrocardiogram. The medications would be administered in thelowest effective dose. It was Dr. Luchetta's opinion that thebenefits of the medications outweigh the harmful side effects andthat respondent lacks the capacity to make a reasoned or informeddecision about such treatment. On several occasions Dr. Luchettaattempted to discuss with respondent the advantages anddisadvantages of the medications listed in the petition, butrespondent refused to discuss treatment, or responded by swearing,walking away, or talking about an unrelated matter. Finally, Dr.Luchetta testified that less restrictive services, such as anoutpatient program or counseling, are not viable options.

Dr. Nageswara Rao Nagarakanti, respondent's treatingpsychiatrist at the time of the hearing, also testified. He agreedwith the medication recommendations set forth in the petition andhad attempted, on three or four occasions, to discuss thesemedications with respondent. She denied having a mental illnessand told Dr. Nagarakanti that she did not need any medication. Inlight of her psychosis, Dr. Nagarakanti did not believe thatrespondent had the ability to understand the advantages anddisadvantages of the medications.

The State called respondent as its final witness. She testifiedthat she had been "abducted, drugged and detained" at the EMHCby a man she had never met. Upon questioning by the State,respondent recounted her cancer-related surgery and stated that shehad seen no proof that the cancer had not recurred. Dr. Luchettahad earlier testified that respondent had cervical cancer in 1982,but that a test performed in September 1999 showed normalresults. When asked about other physical ailments, respondenttestified that the EMHC had sent her to a dentist, she had teethremoved, and she was given an overdose of penicillin or someother medication. Respondent stated that, rather than being treatedat the EMHC, she should have been taken to an oncologist for anexamination of the lump in her throat.

Respondent further testified that Dr. Nagarakanti only wantsto sell her drugs and that "[w]hen something does not agree withwhat [Dr. Luchetta's] diagnosis is, it disappears." Respondentstated that she observed her case worker and other people goingthrough her medical records and "things being discarded into thegarbage."

Respondent also made reference to being restrained at theEMHC and described various incidents in which she had beeninjured by other patients. She indicated that the EMHC staff is notresponsive when such incidents occur.

Finally, respondent testified that she did not want to bemedicated because it caused her pain, although she also stated thatthe pain occurs both on and off the medication. She also indicatedthat the medication made her dry and constipated, caused her noseto bleed, blurred her vision, and impaired her concentration.

Respondent called no witnesses and the trial court denied hermotion for a directed verdict. Following deliberations, the juryreturned a verdict in favor of the State and against respondent,finding her to be "someone who qualifies for the involuntaryadministration of psychotropic medication." The trial court enteredan order authorizing the administration of psychotropic medicationfor a period not to exceed 90 days. The order listed the sixmedications and dosage ranges. Respondent appealed, arguing thatshe was denied her right to due process when the trial courtimproperly instructed the jury under the 1998 version of section2-107.1, and when the trial court gave the jury a general verdictform that did not permit it to specify which medications wereappropriate.

With one justice dissenting, the appellate court reversed. No.2-00-1130 (unpublished order under Supreme court Rule 23).Citing In re Nancy M., 317 Ill. App. 3d 167 (2000), the appellatecourt held that the jury was required to specify in its verdict whichmedications were appropriate, and that the general verdict form"failed to show that the jury clearly intended to authorize theadministration of all six medications listed in the trial court'ssubsequent written order." The dissenting justice disagreed, citingthe reasons set forth in his dissent in In re Frances K., 322 Ill.App. 3d 203, 211-13 (2001) (Grometer, J., dissenting). In thatcase, the dissenting justice criticized Nancy M., stating that,"under the holding of Nancy M., the jury is, in effect, being askedto prescribe the medication and treatment" and that "[s]uch arequirement *** goes far beyond the clear legislative scheme."Frances K., 322 Ill. App. 3d at 213. The appellate court found itunnecessary to consider respondent's argument that the jury wasinstructed under the wrong version of section 2-107.1.

We allowed the State's petition for leave to appeal (see 177Ill. 2d R. 315(a)), and allowed the Illinois State Medical Societyand the Illinois Psychiatric Society to file an amicus curiae briefin support of the State (see 155 Ill. 2d R. 345).

ANALYSIS

I

At the outset, we observe that this case is moot. Section2-107.1 provides that an order authorizing the administration ofinvoluntary treatment shall, in no event, be effective for more than90 days. 405 ILCS 5/2-107.1(a-5)(5) (West 2000).⁽¹⁾ The trialcourt's order granting the petition for involuntary administrationof psychotropic medication was entered on September 18, 2000.The 90 days have long since passed and the trial court'sorder-valid or invalid-no longer has any force or effect. Thus, itis impossible for this court to grant effectual relief to either party,and any decision we render is essentially an advisory one. See Inre Barbara H., 183 Ill. 2d 482, 490 (1998); In re A Minor, 127 Ill.2d 247, 255 (1989). Generally, a reviewing court will not considermoot or abstract questions or render advisory decisions.Steinbrecher v. Steinbrecher, 197 Ill. 2d 514, 523 (2001); BarbaraH., 183 Ill. 2d at 491. We find, however, that this case qualifies forreview under the "public interest exception" to the mootnessdoctrine. The criteria for application of this exception are: (1) thepublic nature of the question; (2) the desirability of anauthoritative determination for the purpose of guiding publicofficers; and (3) the likelihood that the question will recur. In reAdoption of Walgreen, 186 Ill. 2d 362, 365 (1999); Radazewski v.Cawley, 159 Ill. 2d 372, 376 (1994). This case satisfies all threecriteria.

First, the procedures which must be followed and the proofsthat must be made before a court may authorize involuntarytreatment to recipients of mental health services are matters of apublic nature and of substantial public concern. See generally Inre C.E., 161 Ill. 2d 200, 213-19 (1994) (discussing the state'sparens patriae interest in furthering the treatment of mentally illpersons and the liberty interests implicated where treatment isinvoluntarily administered). The question we considerhere-whether the Code permits selective authorization ofpsychotropic medication-is likewise a matter of substantial publicconcern. Second, an authoritative determination is desirable inlight of the conflict in the case law on this issue. Compare NancyM., 317 Ill. App. 3d at 178-79 (holding that the jury was requiredto make findings, either in special interrogatories or in its verdict,as to whether the benefits of a particular medication outweighedthe harm), and Frances K., 322 Ill. App. 3d at 209-10 (followingNancy M. and holding that the verdict form, which did not includeany space for the jury to determine the medications or doses to beadministered, required reversal), with In re R.W., 332 Ill. App. 3d901, 911 (2002) (holding that section 2-107.1 does not require aspecialized verdict addressing each particular medication), petitionfor leave to appeal pending No. _____. Finally, because of therelatively short duration of involuntary treatment orders, thecircumstances present in this case will recur. Review is, therefore,appropriate.

II

Section 2-107.1 of the Code sets forth the standards andprocedures that must be satisfied for the administration of"[a]uthorized involuntary treatment" to adult recipients of mentalhealth services. "Authorized involuntary treatment" is defined as"psychotropic medication or electro-convulsive therapy [ECT],including those tests and related procedures that are essential forthe safe and effective administration of the treatment." 405 ILCS5/1-121.5 (West 2000). Section 2-107.1 applies where a personwho is receiving mental health services is unable to make adecision in his or her own behalf regarding the administration ofpsychotropic medication or ETC. See C.E., 161 Ill. 2d at 228. Theprocedures set forth in this section of the Code ensure thatinvoluntary treatment will be used for therapeutic purposes onlyand not simply as a means to manage or discipline recipients ofmental health services. See C.E., 161 Ill. 2d at 218-19.

Proceedings under section 2-107.1 are initiated by the filingof a petition in the circuit court. The court is required to hold anevidentiary hearing on the petition within the prescribed period.See 405 ILCS 5/2-107.1(a-5)(2) (West 2000) (setting forth theinitial time frame and allowable continuances). Significantly,section 2-107.1 provides that authorized involuntary treatmentshall not be administered unless it is determined, by clear andconvincing evidence, that the following seven factors are present:

"(A) That the recipient has a serious mental illness ordevelopmental disability.

(B) That because of said mental illness ordevelopmental disability, the recipient exhibits any one ofthe following: (i) deterioration of his or her ability tofunction, (ii) suffering, or (iii) threatening behavior.

(C) That the illness or disability has existed for a periodmarked by the continuing presence of the symptoms setforth in item (B) of this subdivision (4) or the repeatedepisodic occurrence of these symptoms.

(D) That the benefits of the treatment outweigh theharm.

(E) That the recipient lacks the capacity to make areasoned decision about the treatment.

(F) That other less restrictive services have beenexplored and found inappropriate.

(G) If the petition seeks authorization for testing andother procedures, that such testing and procedures areessential for the safe and effective administration of thetreatment." 405 ILCS 5/2-107.1(a-5)(4) (West 2000).

The focus of this appeal is factor (D): "That the benefits of thetreatment outweigh the harm."

Consistent with the appellate court's decision, respondentmaintains that a special verdict form is required in a section2-107.1 hearing so that the jury may selectively authorize theinvoluntary administration of only those medications it hasdetermined are more beneficial than harmful. See Nancy M., 317Ill. App. 3d at 178-79; Frances K., 322 Ill. App. 3d at 209-10. TheState argues that section 2-107.1 only requires the jury to pass onthe propriety of the treatment as a whole and that the legislaturedid not intend for jurors to "pick and choose" among the medicinalcomponents of the treatment. According to the State, the use of aspecial verdict form, listing specific medications and dosages,would allow the jury to invade the province of qualified andknowledgeable physicians. See Frances K., 322 Ill. App. 3d at 213(Grometer, J., dissenting); R.W., 332 Ill. App. 3d at 911 (findingthe dissent in Francis K. persuasive). Whether section 2-107.1permits selective authorization of psychotropic medication, andthus requires the use of a special verdict form, is a matter ofstatutory construction. Our review, therefore, proceeds de novo.People ex rel. Devine v. $30,700 United States Currency, 199 Ill.2d 142, 148-49 (2002).

The primary rule of statutory construction is to ascertain andgive effect to the intent of the legislature. Belleville Toyota, Inc. v.Toyota Motor Sales, U.S.A., Inc., 199 Ill. 2d 325, 342 (2002);Lulay v. Lulay, 193 Ill. 2d 455, 466 (2000). The most reliableindicator of the legislature's intent is the language used in thestatute, which must be given its plain and ordinary meaning.Where the statutory language is clear and unambiguous, it will begiven effect without resort to other aids of construction. Lulay, 193Ill. 2d at 466. Based on the plain language of section 2-107.1, wehold that the statute does not permit selective authorization ofpsychotropic medication.

Section 2-107.1(a-5)(4)(D) requires the fact finder toconsider, inter alia, whether the benefits of the recommended"treatment" outweigh the harm. 405 ILCS 5/2-107.1(a-5)(4)(D)(West 2000). Although treatment with psychotropic medicationmay involve the administration of a single drug (see, e.g., In reMiller, 301 Ill. App. 3d 1060, 1065-66 (1998)), treatmentfrequently involves the administration of several medications (see,e.g., R.W., 332 Ill. App. 3d at 903-04; In re Williams, 305 Ill. App.3d 506, 507-08 (1999); In re Barry B., 295 Ill. App. 3d 1080, 1083(1998); In re Perona, 294 Ill. App. 3d 755, 767 (1998)). Nothingin the language of section 2-107.1 indicates that where thetreatment involves more than one medication, the legislatureintended the jury to parse the treatment and choose among thevarious medications. Similarly, nothing in the language of section2-107.1 indicates that the legislature intended treatment orders toauthorize something less than what the treating physician hasprescribed. Accordingly, where, as here, the recommendedtreatment consists of multiple medications-some to beadministered alternatively, some to be administered incombination, and some to be administered only as needed tocounter side effects-it is only this treatment, in its entirety, thatmay be authorized.

Respondent contends that because the statute does notexpressly prohibit selective authorization, it is impliedly allowed.We disagree. Statutes should be construed in a manner that avoidsabsurd, unreasonable, unjust or inconvenient results. In re B.C.,176 Ill. 2d 536, 543 (1997); Collins v. Board of Trustees of theFiremen's Annuity & Benefit Fund, 155 Ill. 2d 103, 110 (1993).Construing the statute to permit selective authorization of onlycertain medications would permit the jury to substitute a treatmentdifferent from the one recommended by the testifying physicianand set forth in the petition. As this court has recognized, however,the diagnosis and treatment of mental health disorders is a" 'highly specialized area of medicine which is better left to theexperts.' " C.E., 161 Ill. 2d at 229, quoting In re Ingersoll, 188 Ill.App. 3d 364, 368 (1989). Indeed, section 2-107.1 vests thephysician authorized to administer the involuntary treatment"complete discretion" not to administer the treatment. 405 ILCS5/2-107.1(a-5)(6) (West 2000). It is thus not for the trial court orthe jury to "develop a course of treatment and then dictate thatcourse to the treating physician. That would constitute rolereversal." In re Gwendolyn N., 326 Ill. App. 3d 427, 431 (2001).In the words of amici curiae, allowing the layperson jury todetermine which of the various medications should beinvoluntarily administered "dangerously approaches the practiceof medicine." Certainly the legislature could not have intendedsuch an unreasonable result.

The appellate court's decision in Nancy M., cited byrespondent as well as the appellate court below, does not persuadeus that selective authorization is permitted under the statute. InNancy M., the circuit court, following a jury trial, entered an orderauthorizing the involuntary administration of three psychotropicmedications. The appellate court reversed, agreeing with therespondent that the verdict form should have listed each requestedmedication and that the general verdict form failed to afford thejurors an opportunity to determine which medication therespondent should have been involuntarily administered. NancyM., 317 Ill. App. 3d at 176-79. The Nancy M. decision, in turn,was based on the reasoning and analysis in In re Len P., 302 Ill.App. 3d 281 (1999). In Len P., the respondent challenged the trialcourt's involuntary treatment order because it failed to specify thedrugs to be administered and the dosages, contrary to the expressrequirements of the Code. See 405 ILCS 5/2-107.1(a-5)(6) (West2000). The appellate court reversed. The appellate court noted thatthe type of medication to be used is a necessary component of theState's burden to prove that the benefits of the medicationoutweigh the harm. The physician's testimony on this subject,however, was vague. Because the trial transcript could not providethe essential information missing from the trial court's order, theerror was more substantive than procedural, and reversal wasrequired. Len P., 302 Ill. App. 3d at 285-86.

Plainly, the issue addressed in Len P. is not the same issue weaddress in the instant case. Len P. considered only whether thecircuit court's treatment order must be reversed where neither theorder, nor the trial transcript, provided the required specificity asto the medications and dosages. Here, we consider whether thestatute permits the fact finder in a section 2-107.1 proceeding toparse the recommended treatment and selectively authorize onlycertain requested medications. Because Nancy M. relied on Len P.,and Len P. considered a different issue than the one raised in thiscase, Nancy M. does not provide a sound basis for construingsection 2-107.1 in the manner advanced by respondent and setforth in the appellate court's order. Further, to the extent Nancy M.and subsequent cases conflict with our holding today, they areoverruled.

Respondent also argues that the statute's requirement thattreatment orders specify the medications and dosages authorizedis evidence that the legislature intended selective authorization ofmedication. We disagree. In light of the substantially invasivenature of involuntary treatment, the liberty interests implicatedwhen a person is medicated against his or her will, and thepotential for misuse of psychotropic medication (see C.E., 161 Ill.2d at 213-15), we believe that the specificity requirement forinvoluntary treatment orders reflects the legislature's legitimateconcern that only qualified health care professionals, familiar withthe respondent's mental and physical status, be permitted toadminister the treatment and that the respondent, as well as thetreaters, be notified of the exact nature of the treatment authorized.See Williams, 305 Ill. App. 3d at 510-11; Miller, 301 Ill. App. 3dat 1072; accord In re Cynthia S., 326 Ill. App. 3d 65, 68-69(2001). That the legislature has prudently provided for specificityin treatment orders entered by the trial court does not lead to theconclusion, however, that the legislature intended a similarrequirement in the verdict form so that the jury may decide whichof the medicinal components of the proposed treatment should beadministered.

We note first that the legislature has employed differentlanguage in the subsection requiring specificity in treatment ordersand the subsection addressing the findings necessary beforeinvoluntary treatment may be authorized. The subsection settingforth the requirements for treatment orders states:

"An order issued under this subsection *** shalldesignate the persons authorized to administer theauthorized involuntary treatment under the standards andprocedures of this subsection ***. Those persons shallhave complete discretion not to administer any treatmentauthorized under this Section. The order shall also specifythe medications and the anticipated range of dosages thathave been authorized." 405 ILCS 5/2-107.1(a-5)(6)(West 2000).

In contrast, the subsection addressing the findings required beforeinvoluntary treatment may be authorized states that "involuntarytreatment shall not be administered to the recipient unless it hasbeen determined by clear and convincing evidence that *** thebenefits of the treatment outweigh the harm." 405 ILCS5/2-107.1(a-5)(4)(D) (West 2000). It is a basic rule of statutoryconstruction that, "by employing certain language in one instanceand wholly different language in another, the legislature indicatesthat different results were intended." In re K.C., 186 Ill. 2d 542,549-50 (1999). Accordingly, we will not assign the same meaningto these two subsections or engraft the specificity requirementfrom one subsection onto the other subsection.

In addition, we note that the legislature has seen fit to amendthe Code numerous times, and that the legislature amended section2-107.1 in 1997, adding the express requirement that treatmentorders specify the medications and dosages. See Pub. Act 90-538,eff. December 1, 1997. Had the legislature also intended to permitselective authorization of medication, it could have done so. Thelegislature has not seen fit to amend the statute in this fashion, andwe will not, under the guise of statutory construction, inject thisprovision into the statute. See People ex rel. Devine, 199 Ill. 2d at150-51 (court will not depart from plain language of statute byreading into it exceptions, limitations or conditions not expressedby the legislature); People v. Tucker, 167 Ill. 2d 431, 437 (1995)(court would not rewrite statute under guise of statutoryconstruction).

Respondent argues in the alternative that section 2-107.1 ofthe Code must be construed in harmony with other statutes relatingto the same subject matter. See People v. Maya, 105 Ill. 2d 281,286-87 (1985). Respondent directs our attention to the Powers ofAttorney for Health Care Law (755 ILCS 45/4-1 et seq. (West2000)) and the Mental Health Treatment Preference DeclarationAct (755 ILCS 43/1 et seq. (West 2000)).

The Powers of Attorney for Health Care Law allows anindividual, the "principal," to designate a "trusted agent *** tomake personal and health care decisions" in the event the principalbecomes disabled. 755 ILCS 45/4-1 (West 2000). Health carepowers that the individual may delegate to his or her agent"include, without limitation, all powers an individual may have tobe informed about and to consent to or refuse or withdraw anytype of health care for the individual." 755 ILCS 45/4-3 (West2000). The agent's authority "may extend beyond the principal'sdeath if necessary to permit anatomical gift, autopsy or dispositionof remains." 755 ILCS 45/4-3 (West 2000). The agent has thesame access to the principal's medical and mental health recordsas the principal would have. 755 ILCS 45/4-7(c) (West 2000).

The Mental Health Treatment Preference Declaration Actallows an "adult of sound mind" to make an advance "declarationof preferences or instructions regarding mental health treatment."755 ILCS 43/10(1) (West 2000). The declaration may include"consent to or refusal of mental health treatment." 755 ILCS43/10(1) (West 2000). "Mental health treatment" includes, amongother things, treatment with psychotropic medication. 755 ILCS43/5(7) (West 2000). The declaration may designate an adult to actas "attorney-in-fact" to make decisions about treatment when thedeclarant is incapable. 755 ILCS 43/15, 43/30 (West 2000). Theform of declaration set forth in the statute provides that thedeclarant may indicate that he or she consents to, or does notconsent to, the administration of particular psychotropicmedications. 755 ILCS 43/75 (West 2000). A declarationdesignating an attorney-in-fact remains in effect until it is revokedor the attorney withdraws. 755 ILCS 43/10(2), 50, 70 (West 2000).

Respondent contends that the foregoing statutes, and section2-107.1, all relate to the provision of health care treatment andshould be construed in a single fashion. Specifically, respondentcontends that the fact finders in a section 2-107.1 proceeding, likethe "surrogate decision makers" in the foregoing statutes, must beallowed to selectively authorize only some of the medicationscomprising the prescribed treatment plan.

Although the Powers of Attorney for Health Care Law, theMental Health Treatment Preference Declaration Act, and theCode each provide a mechanism for making treatment decisionswhere an individual is deemed incapable of doing so, the jury ina section 2-107.1 proceeding functions differently than anindividual's "trusted agent" (755 ILCS 45/4-1 (West 2000)) or"attorney-in-fact" (755 ILCS 43/15 (West 2000)). The jury in asection 2-107.1 proceeding has no prior relationship with therespondent, no prior knowledge of the respondent's preferencesregarding mental health treatment, and no on-going relationshipwith the respondent or the respondent's treating physicians.Rather, the jury functions within the framework of an adversarialproceeding and is called upon, as an impartial fact finder, to makea single decision regarding the respondent's mental healthtreatment based solely on the evidence and argument presented atthe hearing. Once the jury renders its verdict, the jury is dischargedand its limited involvement with the respondent's health careceases. These significant differences persuade us that section2-107.1 should not be construed to provide the jury the samepowers expressly accorded to an individual's "trusted agent" or"attorney-in-fact." Consequently, we will not read section 2-107.1to permit selective authorization of medication.

Respondent additionally argues that prohibiting selectiveauthorization of medication could result in a petitioner requestingauthority to administer an "unlimited" number of medications,thus "forcing" fact finders to condone a physician's "mereexperimentation." Although we are aware of the potential formisuse of psychotropic medication (see C.E., 161 Ill. 2d at 215),we do not share respondent's fear that mental health patients willbe subjected to "mere experimentation" if trial judges and juriesare not allowed to selectively choose which medications should beadministered. The specificity requirement for involuntarytreatment orders (405 ILCS 5/2-107.1(a-5)(6) (West 2000))precludes a court from entering an order permitting an "unlimited"number of medications to be administered to the respondent.Further, the statute's requirement that the petitioner demonstrate,by clear and convincing evidence, "[t]hat the benefits of thetreatment outweigh the harm" (405 ILCS 5/2-107.1(a-5)(4)(D)(West 2000)) militates against the petitioner presenting a treatmentplan that is so ill-defined as to constitute mere experimentation.Finally, respondent's concern that, in the absence of selectiveauthorization, physicians will be permitted to experiment on theirmental health patients is contrary to respondent's position that the"complete discretion" physicians enjoy under the Code (405 ILCS5/2-107.1(a-5)(6) (West 2000)) actually ensures thatimprovidently entered treatment orders pose no risk to the patient.Accordingly, we reject respondent's "mere experimentation"argument.

Because we hold that section 2-107.1 of the Code does notpermit selective authorization of psychotropic medication, we alsohold that a special verdict form, listing each individual medicationand accompanying dosage range, is not required in a section2-107.1 proceeding. Thus, a general verdict form, like the oneused in this case, comports with the statute. By signing the generalverdict form, the jury necessarily found that the State had provedeach of the factors set forth in section 2-107.1, including that "thebenefits of the treatment outweigh the harm." 405 ILCS5/2-107.1(a-5)(4)(D) (West 2000).

III

As a final matter, we consider whether remand to theappellate court is appropriate. As indicated earlier, respondentraised two issues in the appellate court. Based on the appellatecourt's ruling on the selective-authorization issue, the court foundit unnecessary to consider respondent's argument that she wasdenied due process when the trial court instructed the jurypursuant to the 1998 version of section 2-107.1, rather than,presumably, the version in effect at the time of the proceeding in2000. Respondent has not pressed this argument before this courtand we find it unnecessary to remand this matter to the appellatecourt for consideration of this issue.

A reviewing court's determination of whether the jury wasproperly instructed can have no effect on the outcome of the casein light of the significant time that has passed since the 90-daytreatment order was entered. Thus, the issue is moot. See BarbaraH., 183 Ill. 2d at 490-91. Further, it is highly unlikely that theclaimed error would recur. Thus, it does not qualify for reviewunder the recognized exceptions to the mootness doctrine. See Inre A Minor, 127 Ill. 2d at 257-58. Assuming arguendo that thisissue was appropriate for review, based on our examination of therecord, the claimed error in the jury instructions would not haveaffected the outcome of the proceeding.

CONCLUSION

As discussed above, we conclude that (i) the issue of selectiveauthorization of psychotropic medication under section 2-107.1 ofthe Code qualifies for review under the public interest exceptionto the mootness doctrine; (ii) the Code cannot reasonably beconstrued to permit selective authorization of psychotropicmedication and, thus, a special verdict form is not required in asection 2-107.1 proceeding; and (iii) remand to the appellate courtis unnecessary. Consequently, we reverse the judgment of theappellate court and affirm the judgment of the circuit court.

Appellate court judgment reversed;

circuit court judgment affirmed.

1. ¹All citations to the Code are to that version in effect at the time ofthe section 2-107.1 hearing in this case.