Are the ideals of “health democracy” compatible with involuntary care? In this article, we study the forms of participation of psychiatric patients undergoing involuntary care in New York. We focus on the work of lawyers specialized in their defense, drawing on observations of more than two-hundred judicial hearings. We show that, through negotiations with treatment teams before the hearings and certain legal strategies during them, these lawyers can manage to reconcile the participation of the patient in the legal proceeding and their participation in their care, even when that care is involuntary. On the other hand, in the case of a complete refusal of care, the only possibility of victory for the legal defense is to remove the patient from the healthcare system entirely. This article thus shows the tensions and difficulties of creating participation in care and in the legal system at the same time.