Issue: Whether a prisoner in a correctional facility has the right to refuse the administration of psychotropic drugs

Index Topics: Medication (Right to Refuse)

Facts: A prisoner in a state correctional facility who had been diagnosed with bipolar disorder filed a case in state court claiming that the failure to provide a judicial hearing before the involuntary administration of antisychotic medication violated the Due Process, Equal Protection, and Free Speech clauses of the Constitution. After a bench trial, the court held that the prisoner had a liberty interest in not being subjected to the involuntary administration of psychotropic medication, but that the procedure embodied in the facility's policy satisfied constitutional requirements. The Washington Supreme Court reversed, holding that, under the Due Process clause, a State could administer antipsychotic medication to a competent, nonconsenting inmate only if, in a judicial hearing at which that inmate had the full panoply of adversarial procedural protections, the State proved by "clear, cogent, and convincing evidence" that administration was necessary and effective to further compelling state interests. The US Supreme Court granted certiorari.

APA's Position: APA submitted an amicus brief in support of the inmate arguing that: (1) due process requires that a prisoner receive an impartial hearing before he can be forced to take psychotropic medication because medication may have severe side effects and indiscriminate and incorrect use of these medications exacerbate these side effects; (2) forcible administration and significant changes in conditions of confinement implicate basic liberty interests and prisoners usually have a right to refuse invasive and dangerous therapies; (3) abridgment of this constitutional right requires due process (i.e. constitutional rights of prisoners may be limited only as required for correctional operations and involuntary administration of antipsychotic drugs is proper only if an unbiased decisionmaker concludes that the prisoner is dangerous or incompetent and that alternative treatments have failed).

Results: The US Supreme Court reversed, finding the use of an internal decisionmaker adequate under the lesser standard of review embodied in Turner v. Safely, 482 U.S. 78 (1987) - - where fundamental rights are involved and the state, under other circumstances would have been required to satisfy a more rigorous standard of review, action by a correctional facility is constitutional when "reasonably related to a legitimate penological interest." It noted that medical authorities are better able than judges to determine the necessity of the administration of medication and that the policy under which the prisoner was to be treated was a proper "accommodation between an inmate's interest in avoiding the forced administration of antipsychotic medication and the State's interest in providing appropriate treatment to reduce the danger that an inmate suffering from a mental disorder represents to himself or others."