Mental illness and medication at the Supreme Court

[Woofer]

http://www.csmonitor.com/2003/0617/p01s01-usju.html


To stand trial, defendants can be medicated by force

High court rules that state can use drugs when mentally ill defendant is facing trial.

By Warren Richey | Staff writer of The Christian Science Monitor

WASHINGTON – The US government can forcibly administer mind-altering drugs to render criminal defendants competent to stand trial, but only under certain limited circumstances.
In a case with potential implications for those opposed to conventional medical care, the US Supreme Court ruled 6 to 3 Monday that the government's interest in bringing defendants to trial outweighs an individual's decision to be free from forced medication.



The high court declined to find that individuals possess a fundamental right under the Constitution to reject forced medication. The decision doesn't discuss this issue. Instead, the majority concluded that the government has the power to take action when a defendant is "mentally ill" and facing "serious criminal charges."

In the majority opinion, Justice Stephen Breyer established a new legal standard that substantially narrows the permissible circumstances for such government action. "This standard will permit involuntary administration of drugs solely for trial competence purposes in certain instances. But those instances may be rare," Justice Breyer writes.

The high court outlined four conditions that a court must meet to approve the forcible medication of a defendant. First, the court must find important government interests are at stake. Second, it must conclude that involuntary medication will significantly further those government interests. Third, the court must conclude that involuntary medication is necessary to further those interests. And fourth, it must conclude that administration of the drugs is medically appropriate in light of the patient's best medical interests.

The justices also noted that a court must find administration of the drugs is substantially unlikely to have side effects that will significantly interfere with a defendant's ability to assist in his or her defense at trial.

Breyer was joined in the majority opinion by Chief Justice William Rehnquist and Justices John Paul Stevens, Anthony Kennedy, David Souter, and Ruth Bader Ginsburg.

The decision comes in the case of a St. Louis dentist, Charles Sell. He was charged in 1997 with running a Medicaid insurance fraud scheme. Dr. Sell has been diagnosed with a mental illness, called delusional disorder - persecutory type, which has rendered him incompetent to stand trial.

Medical experts hired by the government say that certain antipsychotic drugs could restore Sell's competence and permit him to stand trial. But Sell's lawyer says Sell has had bad experiences with side effects from such drugs and refuses to take them.

The appeals court in Sell's case ordered that he be forcibly medicated.

The Supreme Court's decision vacates that ruling and remands the case back to the lower courts to apply the new, tougher standards.

Sell's lawyer, Barry Short, says the decision is a clear victory. "It is going to be much more difficult for the government to ever be able to force medication on somebody who doesn't want it," he says.

Sell's case is unique in that the court determined he was legally incompetent to stand trial but he was nonetheless competent to make his own medical decisions. In addition, the appeals court ruled that he did not pose a danger to himself and others.

In the high court's ruling, the justices say that assuming that Sell is not dangerous, the appeals court was wrong to approve forced medication solely to render Sell competent to stand trial.

The Sell case had raised concerns by civil libertarians who were worried about the possible broader implications of the case. Some questioned whether the same legal approach might be used to justify requirements by a local school board that unruly children take Ritalin as a condition of attending public school. Others questioned whether criminal defendants have a First Amendment right to think and act in a certain way without being subjected to the influence of antipsychotic drugs.

The high court dodged these broader issues by writing a narrow decision.

In a dissent, Justice Antonin Scalia says he is concerned that the decision may create grounds for certain defendants to delay their trials. "Monday's narrow holding will allow criminal defendants in petitioner's position to engage in opportunistic behavior," he writes. "They can, for example, voluntarily take their medication until halfway through trial, then abruptly refuse and demand an appeal."

It remains unclear what will happen to Sell, but one outcome is that he could be ordered released as a result of the long time he has spent in pretrial custody. Sell has been held for almost six years. He has already been in federal custody longer than the sentence he would have received under federal-sentencing guidelines if convicted of the fraud charges.

• Linda Feldmann contributed to this report.



On the one hand, I can see this guy has spent more time in prison than he would have if he was convicted and sentenced. On the other hand, the public good is not served by having someone free who refuses to take medication that would make them a more law abiding member of society. I hope that violent criminals would never get released from a mental hospital if this applies to them.

[wouldabeen23]

. "First, the court must find important government interests are at stake. Second, it must conclude that involuntary medication will significantly further those government interests. Third, the court must conclude that involuntary medication is necessary to further those interests. And fourth, it must conclude that administration of the drugs is medically appropriate in light of the patient's best medical interests."

Wow, is big brother watching or not?!! Please define "important government intersts"--silly me, I thought our forefathers wanted a fair and impartial court system....

[MadMax]

Originally posted by wouldabeen23 . "First, the court must find important government interests are at stake. Second, it must conclude that involuntary medication will significantly further those government interests. Third, the court must conclude that involuntary medication is necessary to further those interests. And fourth, it must conclude that administration of the drugs is medically appropriate in light of the patient's best medical interests." Wow, is big brother watching or not?!! Please define "important government intersts"--silly me, I thought our forefathers wanted a fair and impartial court system....

to be fair...my understanding is that this issue specifically relates to those who avoid trial by going off meds in the hopes they are found incompetent to stand trial. that's sounds a lot like obstruction of justice to me. not very different from destroying evidence.

[wouldabeen23]

That is a valid point...it is the "government interests" that makes my skin crawl--ya know?

[MadMax]

Originally posted by wouldabeen23 That is a valid point...it is the "government interests" that makes my skin crawl--ya know?

i understand entirely..at first blush, it sounds really creepy.

[dc sports]

A criminal trial is essentially a lawsuit brought by the government ("the state" or "the people") for a wrong done against society. You often hear lawyers speak in a trial about making a decision "in the best interests of the state," etc. The purpose of due process is to balance the rights of the defendant against the rights of society/the people/the state.

I think that's what the decision refers to. So for example, it would be in the government's best interests to try a defendant for murder, rape, etc. to ensure that (assuming they are guilty) they don't commit further crimes, and are punished. On the other hand, in a Mediciad scam, the person's rights to consent in medical treatment outweigh the state's rights -- since the crime involves money (not a life) and the person is unlikely to be put into a position where they can commit Medicaid fraud again.

This issue has come up on several TV shows / books. The fear is that a person guilty of a crime (say, murder) could stay off their medication and in psychiatric care long enough to weaken their case (witnesses move/die, memories fade). Then possibly be found not guilty a few years later.