"The barbarity of exacting mindless vengeance…":

US court orders treatment to ensure killer is sane enough to be executed:

“A US court of appeal has ruled that a death row prisoner be forcibly treated for psychosis which would make him sane enough to be executed.

A series of court rulings has presented convicted murderer Charles Singleton, his lawyers and prison doctors with an agonising choice.

Should he take the medication voluntarily and be condemned to death or refuse them and be condemned to a life of psychosis? Under the US constitution it is illegal to execute an insane person.

In an extraordinary and sharply divided judgment, the court of appeals in St. Louis has ruled that Singleton should be forced to take medication which will make him fit for execution.

(…) Singleton, who stabbed a shopworker to death in 1979, believes his prison cell is possessed by demons, that a prison doctor implanted a device in his ear and that he is both God and the supreme court.” Guardian UK

‘Barbarity’ is right; this is truly a monstrous travesty of a decision. This Kafkaesque ruling insists that the court did not have to consider the entirety of consequences of forcing the patient to be medicated and that, on balance, the medications would benefit him; that “eligibility for execution is the only unwanted consequence of the medication”. (In actuality, one of the hallmarks of competent decision-making is a grasp of the many layers of the context in which a decision is being made, so that the potential consequences can be weighed in their entirety. You will find this principle in any of the textbooks about competency assesment.) In most states, one can only be forced to take antipsychotic medication against one’s will if incompetent to make the decision for oneself, whereas Singleton’s reasoning seems to indicate to me the essence of competent dcision-making!

Furthermore, the standard a court is supposed to use if they take over discretion from an incompetent person is that of so-called “substituted judgment” — substitute decision makers are charged to base decisions not on what they want for the individual but their best surmise of what the person themselves would choose were they competent to make their decision. By this standard, it would appear to be an open-and-shut case that the substituted judgment would be to refuse medications. In my opinion as a psychiatrist, any physician acting in good conscience ought to refuse to cooperate with this ruling. In a just world no one would treat Singleton’s psychosis under these circumstances. Unfortunately, we do not appear to live in that world any more than the one in which no physician would be the agent of the state in administering lethal injections to the condemned. Let us hope Singleton pursues this to the Supreme Court, not that one can expect much from the current Court…