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The Supreme Court

Limiting Forced Medication

Can the government force psychotic defendants to take drugs? The Supreme Court limited the government's right to do that with the next case I'll review—Sell v. United States.

Just the Facts

In the 1990 landmark case, Washington v. Harper, the Supreme Court ruled that an individual does have the right to avoid the “unwanted administration of antipsychotic drugs.” In that case, the Court set two criteria that must be met before forcing an inmate to take drugs against his or her will:

  • 1. Prisoner must be a danger to himself or others; and
  • 2. Prisoner is seriously disruptive to his or her environment and the treatment is in his or her “medical interests.”

Dr. Charles Sell was a dentist, who in 1997 was charged with fraudulently billing Medicaid and private insurers, as well as with money laundering. He had a history of psychiatric hospitalizations for psychosis. Initially, he was considered competent to stand trial, but as his condition deteriorated over time his competency was questioned. During a bail revocation hearing, he yelled and spit at a magistrate. He also faced additional charges of conspiring to kill a witness and an FBI agent.

Following the incident at the bail hearing, Dr. Sell was sent for another evaluation and was found incompetent to stand trail. He was diagnosed with delusional disorder, persecutory type. He was then sent to a federal medical facility to determine if his competence could be restored. The evaluating physician said he could, but only if he was treated with antipsychotic medication. Dr. Sell refused treatment and remained confined to a federal prison hospital, where he still remained as of 2003.

In 1999 the federal magistrate judge held a competency hearing, and based on testimony from the physicians at the United States Medical Center for Federal Prisoners, which said Sell was a danger to himself and others but medication could render him less dangerous, ordered him to be forcibly medicated. The doctor testified that any serious side effects could be eased and that the benefits outweighed the risks. Additionally, the doctor said the drugs would return him to competency.

Dr. Sell appealed the magistrate's decision to district court. The district court found the dangerous claim erroneous, but concluded that medication was the only viable hope to render Sell competent to stand trial, which was necessary to serve the government's interest in deciding his guilt or innocence. The 8th Circuit Court affirmed the district court. Dr. Sell then appealed to the Supreme Court.

In a 6 to 3 ruling on June 16, 2003, the Supreme Court affirmed the government's authority to administer psychotic drugs to a criminal defendant solely for the purposes of rending him or her competent to stand trial, provided these four criteria are met:

  1. There must be an important governmental interest at stake. Prosecution of serious crimes is an important interest, but it still must be reviewed on a case by case basis. Sell's attorney argued that Sell was already confined for a longer period than would be required from any eventual sentence.
  2. Medication must be substantially likely to render the defendant competent to stand trial without offsetting side effects.
  3. Medication must be necessary to achieve this result, and less intrusive procedures must be unlikely to produce substantially the same result.
  4. Medication must be medically appropriate.

The Supreme Court vacated the lower court rulings and remanded the case back to the district court to consider these criteria.

Justice Breyer wrote the opinion for the Court and was joined by Chief Justice Rehnquist and Justices Ginsburg, Kennedy, Souter and Stevens. Justice Scalia wrote the dissenting opinion and was joined by O'Connor and Thomas. In writing for the Court, Breyer said:

  • “We emphasize 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.”

In writing the dissent, Justice Scalia did not question the criteria set by the Court, but instead questioned the necessity for an interlocutory appeal, which prevented the trial from going forward. Scalia wrote:

  • “Today's narrow holding will allow criminal defendants in petitioner's position to engage in opportunistic behavior. They can, for example, voluntarily take their medication until halfway through trial, then abruptly refuse and demand an interlocutory appeal from the order that medication continue on a compulsory basis …. But the adverse effects of today's narrow holding are as nothing compared to the adverse effects of the new rule of law that underlies the holding. The Court's opinion announces that appellate jurisdiction is proper because review after conviction and sentence will come only after 'Sell will have undergone forced medication—the very harm that he seeks to avoid' … This analysis effects a breathtaking expansion of appellate jurisdiction over interlocutory orders. If it is applied faithfully (and some appellate panels will be eager to apply it faithfully), any criminal defendant who asserts that a trial court order will, if implemented, cause an immediate violation of his constitutional (or perhaps even statutory?) rights may immediately appeal. He is empowered to hold up the trial for months by claiming that review after final judgment 'would come too late' to prevent the violation.”

Since the ruling just came down in June 2003, we won't know its full effects for years to come, but you can be certain it will be used for future appeals and likely make it back to a future Supreme Court.

book cover

Excerpted from The Complete Idiot's Guide to The Supreme Court © 2004 by Lita Epstein, J.D.. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

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