Forcibly medicating someone with powerful antipsychotic drugs is not something the law should allow lightly. As the U.S. Supreme Court has repeatedly acknowledged, individuals have a significant "liberty interest" in avoiding the involuntarily administration of medication. But the court has not gone far enough in protecting this interest in personal autonomy when the state is seeking to force medications to advance its own interests.
In the case of Sell vs. United States, decided last month, the state sought to involuntarily medicate a mentally ill defendant in order to make him competent to stand trial. In a ruling written by Justice Stephen Breyer, the court permitted it, but only under narrow conditions.
Charles Sell had a long history of mental illness. A dentist by profession, Sell was charged with Medicaid fraud in the late 1990s. His prosecution was put on hold when it was determined he was "not competent" to stand trial without medication - drugs Sell refused to take. The question before the court was whether the state's interest in bringing Sell to trial outweighed Sell's right to be free from the involuntary administration of drugs.
In its 6-3 decision, the court could have held that in cases where the sole interest of the state is to hold a trial so as to exact a punishment, it is never appropriate to medicate someone against his will. Psychotropic medications are often bruising regimens that can leave subjects exhausted and somewhat addled, depending upon a patient's individual reaction. Only where it is necessary to prevent a person from being a danger to himself or others should the government be able to override the autonomy of a defendant. But the court wouldn't go that far. Instead, Breyer set up a series of conditions that the government will have to meet in order to forcibly return psychotic defendants to competency for trial. Each, no doubt, will spawn new litigation.
According to the court, the antipsychotic drugs have to be in the defendant's best medical interest and unlikely to cause side effects that will adversely impact the ability of the defendant to assist in his own defense. In addition, the government will have to show that no less intrusive means are available; and the government's interest in going to trial has to be "important."
The ruling conceivably sets the stage for the court to take up the highly disturbing case of Charles Singleton, a death row inmate in Arkansas. A federal appellate court has ruled that the state can forcibly medicate Singleton in order to make him sane enough to execute. Singleton has appealed and the high court has not yet decided whether to accept his case.
Breyer's ruling seems to indicate the court has little interest in allowing the government's criminal justice interests to trump an individual's control of his body and health concerns. That is certainly a step in the right direction, but it could have been a more forceful step.
