Constitutional Law - Substantive Due Process - Pennsylvania Supreme Court Holds That Criminal Defendant's Best Interests Justify Forcible Medication

Harvard Law Review, May 2009 | Go to article overview

Constitutional Law - Substantive Due Process - Pennsylvania Supreme Court Holds That Criminal Defendant's Best Interests Justify Forcible Medication


CONSTITUTIONAL LAW--SUBSTANTIVE DUE PROCESS--PENNSYLVANIA SUPREME COURT HOLDS THAT CRIMINAL DEFENDANT'S BEST INTERESTS JUSTIFY FORCIBLE MEDICATION.--Commonwealth v. Sam, 952 A.2d 565 (Pa. 2008).

When deciding if the government may force a mentally ill individual to take antipsychotic drugs, courts must strike a delicate balance between important governmental interests and an individual's right to bodily integrity. (1) The Supreme Court held in Washington v. Harper (2) that antipsychotic medication could be administered against an inmate's wishes "to reduce the danger that [he] represents to himself or others." (3) In Sell v. United States, (4) the Court widened the set of governmental interests that can be used to justify forcible medication of an individual to include rendering a criminal defendant competent to stand trial. (5) Recently, in the companion cases of Commonwealth v. Sam (6) and Commonwealth v. Watson, (7) the Pennsylvania Supreme Court expanded this set of interests even further by holding that Pennsylvania could forcibly medicate incompetent prisoners in order to render them competent to decide whether to pursue relief under the Pennsylvania Post Conviction Relief Act (8) (PCRA). (9) In so holding, the court decided that forcible medication is justified if it furthers the defendant's best interests--and assumed that it could choose among the defendant's competing interests in being free from unwanted medication, in making a competent litigation choice, and in avoiding death. Courts should not decide what defendants' best interests are when they cannot be objectively established; rather, courts should generally defer to the defense counsel's formulation of those interests.

In 1991, Thavirak Sam was convicted of murdering his mother-in-law, brother-in-law, and two-year-old niece and was sentenced to death for each conviction. (10) In 1997, Sam's right to petition for post-conviction relief under the PCRA (11) was about to expire, but Sam was mentally ill and unable to comprehend his rights. (12) In order to prevent Sam from unknowingly waiving his rights, a nonprofit attorney filed a PCRA petition on Sam's behalf, without authorization from Sam or a court appointment. (13) The Court of Common Pleas in Philadelphia County ("PCRA court") agreed to hear the case and appointed Sam a new lawyer for the PCRA proceedings. (14) Sam was subsequently examined by mental health professionals for both parties, and based on the professionals' determinations, all parties agreed that Sam was incompetent to proceed with his PCRA petition. (15) In response, the Commonwealth filed a Motion to Compel Psychiatric Medication in order to render him competent to decide whether to proceed. (16)

The PCRA court denied the Commonwealth's motion. (17) First, the court determined that Sam was not a danger to himself or others. (18) The court then laid out the four-factor Sell test, explaining that in order to medicate a defendant, the government must establish that (1) an important governmental interest is at stake, (2) "the proposed treatment is substantially likely to render [the] Defendant competent and is substantially unlikely to have side effects that may undermine the fairness of the proceedings," (19) (3) involuntary medication is necessary to further the governmental interest and alternative treatments "are unlikely to achieve the same results," (20) and (4) the treatment is "medically appropriate." (21) The PCRA court found that the Commonwealth failed to meet its burden under three of the four factors. (22) To begin with, the government's interest in finalizing Sam's conviction was not sufficiently important to override his due process right to bodily integrity. (23) Furthermore, the Commonwealth had not provided a sufficiently concrete plan of treatment and therefore could not prove that medication was substantially likely to render Sam competent or that the treatment was medically appropriate. (24)

The Pennsylvania Supreme Court reversed in a 4-2 decision.

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