Judicial Notebook

The United States Supreme Court recently agreed to decide whether the government may force a nonviolent mentally ill defendant to take psychotropic medication in order to render him competent to stand trial (Sell v. United States, 123 S. Ct. 512 [2002]).

In August 1997, Charles Sell, a dentist, was charged with submitting false Medicaid claims. Initially released on bail, Sell was ordered back to court after allegedly attempting to intimidate a witness. When the judge tried to advise him of his rights, Sell became unruly. His bail was revoked, and the court learned that he plotted to kill a former employee as well as an FBI agent.

Over the next several months, Sell's trial was postponed as psychologists for both sides diagnosed the dentist as suffering a persecutory delusional disorder. The court concluded that Sell was not competent to stand trial and ordered that he be committed to a federal prison hospital to determine whether he was likely to be rendered competent to stand trial. Psychiatrists at the prison facility concluded that Sell needed antipsychotic medication to restore his competency. Sell objected to the medication and, after an administrative appeal of the psychiatrists' decision, took his challenge to federal court.

A danger to self or others?

Initially a federal magistrate concluded that Sell posed a danger to himself and others, and authorized the prison facility to forcibly inject Sell with an antipsychotic medication. Sell appealed to the federal district court, and the judge reversed the magistrate's decision, finding insufficient evidence that Sell posed a danger. Nevertheless, the district court held that the government's interest in restoring Sell's competency to stand trial was, by itself, sufficient justification for forcible medication.

Sell appealed the district court's ruling to the U.S. Court of Appeals for the Eighth Circuit, which agreed that the evidence did not support a finding that Sell posed a danger to himself or others (United States v. Sell, 282 F.3d 560 [2002]). While also concluding that Sell had a "significant liberty interest in refusing antipsychotic medication," the appeals court ultimately affirmed the lower court's decision.

Dissenting from this decision, Judge Kermit E. Bye stressed the need to consider the severity of the charges in deciding whether an incompetent pre-trial detainee could be forcibly medicated: "The government's interest in forcibly medicating an accused murderer may be essential, but its interest in forcibly medicating an accused thief is not."

The Sell case reaches the Supreme Court on the heels of closely related decisions. In Riggins v. Nevada (504 U.S. 127 [1992]), the Supreme Court applied Washington v. Harper (494 U.S. 210 [1990]) to the question of whether a pre-trial detainee could be forcibly medicated in order to restore his competency to stand trial. Riggins, who had been forcibly administered an antipsychotic medication after a state court denied his motion to terminate the medication, failed in his insanity defense, was convicted of murder and was sentenced to death. On appeal, he argued that forcible medication prejudicially affected his attitude, appearance and demeanor at trial and thus interfered with his defense of insanity. The Supreme Court held that Riggins's due process rights had been violated because the state court failed to "acknowledge his liberty interest in freedom from unwanted medication, make any findings on the need for forced medication, and make findings on reasonable alternatives to antipsychotic medication." The court also observed that forcing Riggins to take antipsychotic medications may have interfered with his right to a fair trial. Criminal defendants have a constitutional right not to be tried unless competent, defined as understanding the charges and being able to assist counsel in one's defense.

Clearly the government has a strong interest in seeing that those charged with crimes are brought to trial. In many cases, the defendant also has an interest in being allowed to proceed to trial. For example, when defendants are incompetent due to psychosis, their interests may well be served by using antipsychotic medication to restore their competence. On the other hand, in a case such as Sell, where the defendant might contemplate raising an insanity defense, the courts must weigh the interest in proceeding to trial against the interest in making sure that the trial is fair.

In any event, those interests must be weighed against society's interest in protecting individuals from unwarranted intrusions on their liberty interests. Time will tell how the Supreme Court balances these competing interests, but the concept of dangerousness is likely to play a significant role in the ultimate decision. If that proves to be the case, input from psychologists will become even more important in determining how the law treats defendants deemed incompetent to stand trial.