Should courts be allowed to force mentally ill defendants to take atypical psychotropic medications in order for them to be found competent to stand trial?
Forced medication is a theme I first met while advocating for parents of children diagnosed with ADHD during their early years of elementary school. Could schools require parents to have their children medicated as a condition of continuing in school? I’m not sure that issue is settled, but am thankful most schools have moved beyond that position and are using different approaches to help challenging pupils succeed.
However, courts haven’t come that far. In fact, recently the Oregon Supreme Court ruled that state judges can force defendants to take medication against their will so they can stand trial, cf. Oregon v. James Michael Francis Lopez (2014). The decision was in agreement with an earlier decision by SCOTUS, Sell v. U.S. (2003). From that case, a four-part test has emerged: is the medication appropriate and unlikely to have side effects that would undermine a person’s ability to aid in their own defense? Is there no other alternative to medications? And that forced medications further important government interest in seeing the trial proceed.
It’s important to keep in the mind that the determination of competency to stand trial is very different from the issue of sanity at the time of the offence. The insanity defense involves that state of a person’s mind at the time of the alleged crime. Incompetency to stand trial can be determined sua sponte anytime during the process of the trial. Furthermore, earliest Supreme Court rulings made vigilance concerning a person’s present competency a constitutional mandate placed on all parties in a criminal proceeding.
It is of note that the Sell test is heavily weighed to the Government’s advantage. The court is not required to ask about the side effects of psychotropic medications generally. The only enumerated concern is a defendant’s ability to assist in their own defense. Also lacking is any attempt to decide whether forced medications serve the individual’s interest. What about those who don’t understand their so-called mental illness as a medical problem at all? How about those, such as, who might understand their Voices as a spiritual experience not needing to be synthetically extinguished?
Traditionally a very low bar has been used in determining competency at trial – does the defendant understand the proceeding and can they assist in their own defense? Understanding the proceeding usually means a person can describe a courtroom, can identify the judge, and is aware they are on trial. Assisting in their own defense usually means they are cooperating enough with their attorney that they don’t interrupt the proceedings. Given the complexity of every court case, this primitive test seems ludicrous. I wonder how many folks sit in court wondering, “What’s happening here?” Do many of us really understand the language being used? The motions made? Judges decisions implemented? And if we don’t understand, how can us, “assist in our own defense?”
At a more fundamental level, how can a society that lacks the will to provide mental health resources to its citizens then allow a court to mandate medication for the sole purpose of proceeding with a trial? Or, do we know what’s being done in our name? Do we care?