Forced competence: a defendant's right to reject involuntarily administered antipsychotic drug treatment.

• Author: Logan, April

INTRODUCTION

A defendant's competence to stand trial has long been determined to be one of the many rights that are deemed essential to the fair trial (1) guaranteed by the Sixth Amendment to the United States Constitution. (2) In 1966, the United States Supreme Court held in Pate v. Robinson (3) "that the conviction of an incompetent defendant violates due process." (4) Therefore, "[u]nless [a] defendant is competent, the State cannot put him on trial." (5)

Until recently, the Supreme Court had not decided what measures the Government may take to ensure a defendant's competency. More specifically, the Court had not decided whether the Government might involuntarily administer antipsychotic (6) drugs to a defendant for the purpose of making him competent to stand trial for serious, but nonviolent crimes. In Sell v. United States, (7) however, the Supreme Court concluded that the Constitution permits the Government to administer antipsychotic drugs involuntarily to a defendant in "limited circumstances." (8) More particularly, the Court held that the Government may not administer antipsychotic medication to a defendant against his will when it could not be determined "whether the side effects were likely to undermine the fairness of [the defendant's] trial." (9)

Although the limited holding in Sell protects an individual's right to a fair trial by preventing the administration of antipsychotic drugs against a defendant's will if forcible medication will impede the defendant's ability to receive a fair trial, it does not prevent a non-consenting defendant from being medicated in all instances. In determining whether to administer antipsychotic drugs to a defendant to make him competent, the Court focuses not only on the defendant's interest in refusing to be administered antipsychotic drugs but on the Government's "interest in providing appropriate medical treatment to reduce the danger that a [defendant] suffering from a serious mental disorder [represents] to himself or others." (10)

In light of the aforementioned competing interests, what happens when a convicted defendant, who is competent (forcibly or otherwise) during his trial and sentenced to death, becomes incompetent prior to being executed? May the Government administer antipsychotic drugs in order to render the defendant competent so that he may be executed? What about the defendant's constitutionally protected "liberty interest" in avoiding the unwanted administration of antipsychotic drugs? Is that interest outweighed by the State's interest in bringing the defendant to justice and seeing that his punishment is imposed?

Prior decisions of the United States Supreme Court illustrate that the Eighth Amendment's cruel and unusual punishment clause (11) prohibits the Government from executing an incompetent or insane defendant. (12) However, it was undecided until now whether the Government may force a convicted defendant's competence through the involuntary administration of antipsychotic drugs. Recently, in Singleton v. Norris, the Supreme Court refused to disturb a federal appeals court decision allowing Arkansas state officials to forcibly medicate a convicted murderer in order to render him competent for execution. (13) By declining to address the question of whether a convicted defendant may be forcibly medicated solely for the purpose of his execution, the Supreme Court let stand the lower court ruling and allowed the state to have the final word on whether forced competence was permissible for execution.

This article considers how the Sell decision, allowing the state to administer antipsychotic drugs to an incompetent defendant to render him competent to stand trial, led to the Supreme Court's recent refusal to prevent a state administering antipsychotic drugs to an incompetent convicted murderer against his will to make him competent to be executed. Part I briefly chronicles the prior decisions relied on by the Court that first established an individual's constitutionally protected interest in avoiding the involuntary administration of antipsychotic drugs. Part II examines the Court's opinion in the Sell case. Part HI explores the recent Singleton case and part IV analyzes the Court's decision in the Sell case, particularly emphasizing how the Court's holding helped to mold the Eighth Circuit Court of Appeals' decision allowing convicted murderers to be forced into the competence required to be put to death.

1. LEGAL BACKGROUND

   1. Washington v. Harper

      The United States Supreme Court first recognized an individual's "constitutionally protected 'liberty interest' in 'avoiding the unwanted administration of antipsychotic drugs'" in Washington v. Harper. (14) In Harper, a mentally ill state prisoner was forced to take antipsychotic drugs against his will after a committee hearing determined that the inmate was "a danger to others as a result of a mental disease or disorder," pursuant to the Special Offender Center' s Policy. (15)

      The policy permitted a psychiatrist to approve an order to treat an inmate with antipsychotic drugs against his will if the inmate "(1) suffers from a 'mental disorder' and (2) is 'gravely disabled' or poses a 'likelihood of serious harm' to himself, others, or their property." (16) In addition, before an inmate could be medicated without his consent, the inmate was entitled to a hearing where a majority of "a committee consisting of a psychiatrist, a psychologist, and the Associate Superintendent of the Center" was required to determine that the "inmate suffer[ed] from a mental disorder and [was] gravely disabled or dangerous." (17)

      Harper was involuntarily medicated until he was transferred from the Center to the Washington State Reformatory. (18) Consequently, his condition deteriorated and he was transferred back to the Center where, after another committee hearing, he was again forced to take antipsychotic medication. (19) Harper filed suit in state court challenging the prison policy that authorized the administration of antipsychotic drugs against his will on grounds that it violated his due process rights. (20)

      The trial court held that although Harper "had a liberty interest in not being subjected to the involuntary administration of antipsychotic medication, the procedures contained in the Policy met the requirements of due process." (21) On appeal, the Washington Supreme Court agreed that Harper "had a liberty interest in refusing antipsychotic medications" but concluded "the 'highly intrusive nature' of treatment with antipsychotic medications warranted greater procedural protections" and reversed the trial court's decision. (22) Furthermore, the court held that the state could administer antipsychotic drugs to an inmate without his consent only if the state "proved by 'clear, cogent, and convincing' evidence that the administration of antipsychotic medication was both necessary and effective for furthering a compelling state interest." (23)

      The United States Supreme Court also recognized that an inmate possessed a "significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment;" (24) but that interest must be "defined in context of the inmate's confinement." (25) Considering the Special Offender Center's policy, the Court determined that the State had a legitimate interest in administering the medication, especially when faced with "combating the danger posed by a person to both himself and others ... in a prison environment." (26)

      Thus, the Court held that, "given the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate's medical interest." (27) The policy "is an accommodation between an inmate's liberty interest in avoiding the forced administration of antipsychotic drugs and the State's interests in providing appropriate medical treatment to reduce the danger that an inmate suffering from a serious mental disorder represents to himself or others." (28) Therefore, the Court held that the policy was "permissible under the Constitution" and reversed the decision of the Washington Supreme Court. (29)

   2. Riggins v. Nevada

      In Riggins v. Nevada, a convicted murderer challenged his murder and robbery convictions because the state forced him to take antipsychotic drugs throughout his trial. (30) In Riggins, the Court once again acknowledged an individual's "constitutionally protected liberty interest in freedom" from the involuntary administration of antipsychotic drugs. (31) The defendant, after being arrested for murder and robbery, complained to a psychiatrist who treated inmates at the Clark County Jail...