Consequently, the professional ethics of mental health decisionmakers constitute the only formal barrier to forcible treatment of these patients. Several approaches to remedying this situation have been taken. The Saskatchewan Mental Health Services Act makes the lack of competence to make treatment decisions one of the criteria for involuntary commitment, thereby avoiding many of the problems raised by the right to refuse treatment. A competent patient cannot be involuntarily committed and cannot be treated compulsorily except in an emergency situation. If the patient becomes incompetent after admission, a substitute consent must be obtained from the nearest relative. In Nova Scotia, a competent patient who has been involuntarily committed has been granted the right to refuse treatment. Substitute consent may be obtained should the person become incompetent. This legislation may present problems because of the broad and vague articulation of criteria to be considered in determining the patient's competence to consent to treatment. Ontario's approach allows competent, involuntarily committed patients to refuse treatment and has provisions for obtaining substitute consent, but the right is undermined by the power of a board of review to override either a competent patient's refusal or a substitute decision if the patient is incompetent. 98 footnotes and 1 table.