Should People With Mental Illnesses Be Forced To Take Medication?

Introduction

As a general matter, most of us are free to refuse unwanted medical treatment, even when such treatment may be in our best medical interests; in most circumstances, we may choose to decline blood transfusions, refuse to accept lifesaving cancer treatments, and decide not to vaccinate our children.

In the context of the criminal justice system, however, incarcerated individuals-even those who are awaiting trial and still retain the presumption of innocence-have a reduced right to refuse unwanted medical treatment. Within prison walls the rights of the state must be balanced with the prisoner's right to refuse treatment. Thus, the state may offer a variety of medical and legal reasons to forcibly administer medical treatment to a prisoner, including the need to quell the spread of disease within prison walls; to ensure the physical safety of prisoners and prison personnel; and to "restore" competency to an incompetent defendant so that he may stand trial or even be executed.

It is the latter class of cases-those in which the state seeks to medicate solely or partially for prosecutorial reasons-that are the most troubling of the forced medication cases. Showings by the state that forced medication is medically or penologically appropriate is only part of the equation; the request also is prompted by the state's wish to bring about a legal proceeding. In some cases, an incompetent criminal defendant awaits trial and, without restoration of competency, may be incarcerated indefinitely until competency returns. In others, the defendant is sentenced to death but later deemed incompetent to be executed, and the state seeks to restore competency through forced medication-solely to then execute the prisoner.

Legal Background

In the early 1990s, the U.S. Supreme Court issued two opinions addressing the issue of when, and under what circumstances, mentally ill individuals within the criminal justice system may be forced to take psychotropic medication, either as part of a medical treatment plan or to restore competency to stand trial.

In the 1990 case of Washington v. Harper, 494 U.S. 210, the Court was confronted with a mentally ill incarcerated man who did not want to be medicated by prison psychiatrists. The state made a showing that forced administration of the antipsychotic drug at issue was medically appropriate and that, absent the medication, Harper represented a danger to himself and others. The Court clearly recognized Harper's liberty interest in avoiding the forced administration of antipsychotic medication, as well as the "substantial interference" posed by forcible medication and the tremendous dangers associated with such drugs. It nonetheless held that Harper could be involuntarily medicated given the state's demonstration that the drug regimen was necessary. Further, the Court rejected Harper's claim that the decision to forcibly medicate necessarily had to be made by a judicial decision maker. Instead, the Court reasoned that Harper's interests might well be better served when the decision to medicate was made by a medical professional rather than a judge.

Two years later, in Riggins v. Nevada, 504 U.S. 792, the Court ...