Brief Filed: 12/02
Court: Supreme Court of the United States
Year of Decision: 2003

Issue: Whether a criminal defendant should be involuntary medicated for the purpose of restoring the defendant to competency so that he can stand trial

Index Topics: Medication (Right to Refuse); Competency

Facts: This case addresses issues related to involuntary medication of a criminal defendant in order to restore the defendant to competency so that he can stand trial. Sell is a dentist who was convicted of multiple counts of health care fraud. He was diagnosed as suffering from "delusional disorder," and while the trial court did not find him to be a danger to himself or others, it did conclude that absent antipsychotic medication he was not competent to stand trial. The case raises the question of how to balance the liberty interest to be free from unwarranted intrusions on bodily integrity, the First Amendment interest in controlling one's own thought processes, and the right to a fair trial against the government's interest in obtaining an adjudication of guilt or innocence in a case involving only non-violent offenses. The Eighth Circuit upheld an order mandating involuntary medication. The case was appealed to the US Supreme Court who agreed to address whether the Court of Appeals "erred in rejecting petitioner's argument that allowing the government to administer antipsychotic medication against his will solely to render him competent to stand trial for non-violent offenses would violate his rights under the First, Fifth and Sixth Amendments."

APA's Position: It was recognized that the issues presented in this case closely parallel those in US v. Gomes, 289 F.3d 71 in which APA also participated as an amici. As in Gomes, the brief does not take a position on the ultimate resolution of case, but instead focuses on assisting the Court in understanding the relevant scientific considerations that must inform its decision. APA's brief argues that antipsychotic drugs should not be forcibly administered to a criminal defendant for the purpose of rendering him competent to stand trial unless the government proves to the trial court that less intrusive non-drug alternatives would be ineffective in accomplishing the same objective; that there is a substantial likelihood that the particular drug proposed to be used will render the defendant competent for trial; and that the benefits from that medication clearly outweigh its side effects. APA's brief addresses how antipsychotic medications are often effective in alleviating the psychotic symptoms in a number of mental disorders, how they can restore competency to stand trial, and the side-effects of various antipsychotic drugs. The brief further states that once antipsychotic drugs are administered and the defendant is brought to trial, the government should be required to show that the drugs will not materially impair the defendant's ability to present an effective defense.

Results: The US Supreme Court in a 6-3 ruling stated that the government may involuntarily administer antipsychotic medications to a mentally ill criminal defendant in order to render him 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." The Court clarified 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.