June 17, 2003
Court's Decision in Sell v. United States Reflects Psychology's Recommendation that Alternatives to Drug Therapy Should be Considered
WASHINGTON — In it's decision in Sell v. United States, announced on Monday, June 16, the Supreme Court agreed with a major tenant of an amicus curiae brief filed by the American Psychological Association (APA) -- that courts should consider "alternative, less intrusive means" before forcibly medicating mentally ill criminal defendants. The Court's decision in Sell is furthermore consistent with the test that APA recommended in its brief and cites APA's brief with approval on one important issue.
The APA filed an amicus curiae brief with the Court as a neutral amicus to the Court i.e. not in support of either party.
In Sell, the Court was asked to clarify the circumstances in which a court may order the involuntary administration of antipsychotic medication to a criminal defendant who is incompetent to stand trial, but who is competent to make medical decisions on his own behalf (including the decision to refuse antipsychotic medication) and who is not dangerous to himself or others. In its brief, APA took the position that, although such involuntary administration of antipsychotic medication is not flatly forbidden by the Constitution, its use must be carefully limited to those circumstances where no less intrusive (nondrug-based) approach will be effective, the specific identified medication is substantially likely to be effective at restoring the individual to competency, and the medication is not likely to result in serious adverse side effects.
The Supreme Court agreed with this analysis. In its decision, the Court states (at pp. 11-12):
[T]he Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.
Consistent with APA's analysis, the Court further clarified (at pp. 12-13) that (1) in determining whether the government has an important interest in bringing a defendant to trial, a trial court must consider the possibility that the defendant will be civilly committed, or has already been detained for a lengthy period; (2) the government must show that the medication is substantially likely to render the defendant competent to stand trial; (3) the court must find that no alternative, less intrusive approach is likely to achieve substantially the same result of restoring a defendant to competency; and (4) the particular medication must be in the patient's best interest, taking into account both efficaciousness and side effects.
"The bottom line is that -- thanks to APA's submission -- the Court has specifically required that trial courts consider and rule out nondrug alternatives before ordering involuntary drug treatment," states Nathalie F. P. Gilfoyle, General Counsel for the APA.
A further important point is that the Court made clear that, before ordering involuntary administration of drugs to restore a defendant to competency, a trial court should first consider whether involuntary medication would be justified to address the defendant's dangerousness to himself or others (pp. 14-15). The Court clearly seems much more comfortable with involuntary drug treatment on grounds of dangerousness than with such treatment for restoration of competency. Indeed, the Court specifically remarked that, although involuntary administration of drugs solely for trial competence may be permitted in certain instances, "those instances will be rare" (p. 12).
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.