Brief Fact Summary. An individual had a history of mental illness, but refused to take antipsychotic medicine while confined to a state treatment facility.
Synopsis of Rule of Law. Forcibly medicating an inmate for trial competence purposes is only appropriate in certain instances.
Issue. “[W]hether the Constitution permits the Government to administer antipsychotic drugs involuntarily to a mentally ill criminal defendant–in order to render that defendant competent to stand trial for serious, but nonviolent, crimes[?]” Or, in other words “[d]oes forced administration of antipsychotic drugs to render Sell competent to stand trial unconstitutionally deprive him of his ‘liberty’ to reject medical treatment?”
Held. Yes, “the Constitution allows the Government to administer those drugs, even against the defendant’s will, in limited circumstances.”
Two prior precedents, [Washington v. Harper] and [Riggins v. Nevada] set forth the framework for determining the legal answer. “In Harper, this Court recognized that an individual has a ‘significant’ constitutionally protected ‘liberty interest’ in ‘avoiding the unwanted administration of antipsychotic drugs.’ ” “The Court found that the State’s interest in administering medication was ‘legitima[te]’ and ‘importan[t],’; and it held that ‘the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.’ The Court concluded that, in the circumstances, the state law authorizing involuntary treatment amounted to a constitutionally permissible ‘accommodation between an inmate’s liberty interest in avoiding the forced administration of antipsychotic drugs and the State’s interests in providing appropriate medi
cal treatment to reduce the danger that an inmate suffering from a serious mental disorder represents to himself or others.’ ”
“In Riggins, the Court repeated that an individual has a constitutionally protected liberty ‘interest in avoiding involuntary administration of antipsychotic drugs’–an interest that only an ‘essential’ or ‘overriding’ state interest might overcome.” Further, “The Court suggested that, in principle, forced medication in order to render a defendant competent to stand trial for murder was constitutionally permissible. The Court, citing Harper, noted that the State “would have satisfied due process if the prosecution had demonstrated . . . that treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of Riggins’ own safety or the safety of others.” And it said that the State ” ‘[s]imilarly . . . might have been able to justify medically appropriate, involuntary treatment with the drug by establishing that it could not obtain an adjudication of Riggins’ guilt or innocence’ of the murder charge ‘by us
ing less intrusive means.’ Because the trial court [in Riggins] had permitted forced medication of Riggins without taking account of his ‘liberty interest,’ with a consequent possibility of trial prejudice, the Court reversed Riggins’ conviction and remanded for further proceedings.”
The court observed “[t]hese two cases, Harper and Riggins, indicate that the Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.”
“First, a court must find that important governmental interests are at stake. The Government’s interest in bringing to trial an individual accused of a serious crime is important. That is so whether the offense is a serious crime against the person or a serious crime against property. In both instances the Government seeks to protect through application of the criminal law the basic human need for security.”
“Second, the court must conclude that involuntary medication will significantly further those concomitant state interests. It must find that administration of the drugs is substantially likely to render the defendant competent to stand trial. At the same time, it must find that administration of the drugs is substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel in conducting a trial defense, thereby rendering the trial unfair.”
“Third, the court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.”
“Fourth, as we have said, the court must conclude that administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.”
The court emphasized “that the court applying these standards is seeking to determine whether involuntary administration of drugs is necessary significantly to further a particular governmental interest, namely, the interest in rendering the defendant competent to stand trial. A court need not consider whether to allow forced medication for that kind of purpose, if forced medication is warranted for a different purpose, such as the purposes set out in Harper related to the individual’s dangerousness, or purposes related to the individual’s own interests where refusal to take drugs puts his health gravely at risk. There are often strong reasons for a court to determine whether forced administration of drugs can be justified on these alternative grounds before turning to the trial competence question.”
The majority found that “Court of Appeals was wrong to approve forced medication solely to render [the Petitioner] competent to stand trial. For one thing, the Magistrate’s opinion makes clear that he did not find forced medication legally justified on trial competence grounds alone. Rather, the Magistrate concluded that [the Petitioner] was dangerous, and he wrote that forced medication was ‘the only way to render the defendant not dangerous and competent to stand trial.’ ”
“Moreover, the record of the hearing before the Magistrate shows that the experts themselves focused mainly upon the dangerousness issue. Consequently the experts did not pose important questions–questions, for example, about trial-related side effects and risks–the answers to which could have helped determine whether forced medication was warranted on trial competence grounds alone. Rather, the Medical Center’s experts conceded that their proposed medications had ‘significant’ side effects and that ‘there has to be a cost benefit analysis.’ ”
“The failure to focus upon trial competence could well have mattered. Whether a particular drug will tend to sedate a defendant, interfere with communication with counsel, prevent rapid reaction to trial developments, or diminish the ability to express emotions are matters important in determining the permissibility of medication to restore competence, but not necessarily relevant when dangerousness is primarily at issue. [The majority could not] tell whether the side effects of antipsychotic medication were likely to undermine the fairness of a trial in [the Petitioner’s] case.”
“Finally, the lower courts did not consider that [the Petitioner] has already been confined at the Medical Center for a long period of time, and that his refusal to take antipsychotic drugs might result in further lengthy confinement. Those factors, the first because a defendant ordinarily receives credit toward a sentence for time served, 18 U. S. C. Section:3585(b), and the second because it reduces the likelihood of the defendant’s committing future crimes, moderate–though they do not eliminate–the importance of the governmental interest in prosecution.”
Discussion. This case concerns when a state can force an inmate to take antipsychotic medication.