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.” Christian Science Monitor
If you scan the press coverage of this Supreme Court decision, you will find two distinctly different takes on it. One emphasizes that the Court upheld forced medication; the other that such stringent restrictions were placed on it. The ruling is a victory for the defendant in the case, although it dismisses the notion that there is a fundamental right under the Constitution to refuse treatment. A lower court ruling forcing the defendant to take medications against his will to restore his competency to stand trial was vacated and the court was instructed to reconsider the case with the toughter criteria, which he is not likely to meet.
The criteria are as follows:
- “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.”
While the majority opinion by Justice Breyer cautions that the permissible instances for forced medication may be rare, I am not so sure. Arguably, the government will argue that “important interests” will be met simply by restoring comeptency and allowing someone to be brought to trial, for most crimes even if not for this one. Involuntary medication will usually, if not invariably, be seen as the most expedient if not the only way, and inherently medically appropriate, to further such an objective. I am not saying I agree with construing things in that way, but I predict that is how the criteria will be applied.
The case at hand was one of a dentist indicted for Medicaid fraud who refused to take medication for a mental illness — diagnosed as delusional disorder, persecutory type — which rendered him incompetent to stand trial, i.e. unable to collaborate with his attorney in defending himself (likely because he was too paranoid to trust his lawyer). The article comments:
(The) 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.
This, however, is really not so surprising, since competency is always determined relative to some particular sphere of functioning. Traditionally, courts have had more stringent criteria for finding someone incompetent to make decisions about bodily integrity or sanctity than competency in other spheres. And dangerousness and competency are totally distinct concepts. Although the patient was incompetent, he was not dangerous to self or others, and the Court suggests that in the absence of a burden to protect him or society, the state’s interest, merely to bring him to trial and prosecute for fraud, was not a compelling one and that it was wrong to force him on that account to take medication.
