Mental health clinicians are praising the U.S. Supreme Court ruling that mentally ill defendants may be forcibly medicated to make them competent to stand trial--but only after prosecutors have met strict requirements.
The justices overturned a lower court's decision permitting prosecutors to medicate an unwilling defendant, arguing that those requirements had not been met.
"The decision adopts the general standards for justifying medication to restore competence that the American Psychiatric Association urged in its amicus brief: medical appropriateness, necessity as a practical matter, likely effectiveness, [and] likely absence of fair-trial harms," Dr. Jeffrey Metzner, who chairs the association's Committee on Psychiatry and the Law, told this newspaper. "The majority decision indicates that the use of involuntary medication should only be done after exhausting other alternative involuntary procedures, such as those based on dangerousness."
Rhea Farberman, a spokesperson for the American Psychological Association, said that her organization, which also filed an amicus brief on the case, wanted the court to see that nondrug therapies, such as cognitive-behavioral therapy, for example, should be considered first.
The case of Sell v. United States involved Dr. Charles T. Sell, a St. Louis dentist with a long history of mental illness who resisted prosecutors' attempts to make him take antipsychotic medication so he could stand trial for mail fraud, Medicaid fraud, and money laundering. He has been incarcerated on the current charges since 1998. Before that, Dr. Sell had been hospitalized at least twice since 1982 after claiming, among other things, that communists had contaminated the gold he used for filling teeth, that a government agent was trying to kill him, and that he had held conversations with God.
In 1999, he was sent to the U.S. Medical Center for Federal Prisoners in Springfield, Mo., where a reviewing psychiatrist concluded that Dr. Sell's symptoms pointed to a diagnosis of delusional disorder, with a possible underlying schizophrenic process. The psychiatrist also determined that Dr. Sell was incompetent to stand trial without antipsychotic medication. Medical center staff sought court permission for forcible medication, and Dr. Sell and his attorneys took the case to the high court.
In a 6-3 decision led by Justice Stephen Breyer, the court established four conditions prosecutors must meet to medicate defendants against their will:
* The importance of the government's case must not jeopardize the defendant's ability to receive a fair trial. …