“By Force If Necessary:” Administering drugs to defendants unfit to stand trial

Photo by: Melanie Clayton

On December 24, 2013, the Court of Appeals for the DC Circuit affirmed an order authorizing medication to be administered to Simon Dillon “by force if necessary” so that he would be competent to stand trial.  By weighing the government’s prosecutorial interests above “special circumstances,” the Court’s opinion examines forcibly medicating a defendant to restore his competency.

It is not morally acceptable to punish a defendant who does not understand why he is being punished.

According to Dusky v. United States, competence to stand trial is defined as “a sufficient present ability to consult with one’s attorney with a reasonable degree of rational understanding, and…a rational, as well as factual, understanding of the legal proceedings against him.”  In other words, a defendant must have the capacity to participate in his legal proceeding and understand the nature and purpose of criminal proceedings.  Based on the Dusky decision, it is not morally acceptable to punish a defendant who does not understand why he is being punished. Ensuring that defendants be competent to stand trial preserves the fairness of the adversary system.  A defendant is incompetent to stand trial when he or she suffers from a mental disease or defect that affects his capability to understand the nature and consequences of the proceedings against him or his capability to assist property in his defense.  A serious mental disorder has the potential to conflict with a defendant’s competency and inhibit his communication with counsel.  According to The National Judicial College, around 60,000 court orders call for competency evaluations each year, and twenty percent of these evaluations find that the defendants are incompetent. Prior to Dillon, the Supreme Court dealt with forcing antipsychotic drugs on an incompetent defendant in three cases.   Anti-psychotic drugs are used to treat serious mental illnesses and psychosis such as schizophrenia and, in some cases, can render a defendant competent to stand trial.   The court has recognized a liberty interest in freedom from unwanted antipsychotic drugs in Washington v. Harper, Riggins v. Nevada, and Sell v. United States.

The Court allowed Harper to be forcefully medicated because the facility’s regulations passed due process muster.

In Washington v. Harper, the defendant was imprisoned for violating his parole and was subsequently sent to a facility intended for offenders with serious mental illnesses.  He did not want to be medicated and refused when the facility attempted to administer the medication involuntarily per an internal policy.  Their internal policy would allow involuntary medication when the inmate was “gravely disabled” or “possesses a likelihood of serious harm to himself, others, or their property.”  Here, the Court allowed Harper to be forcefully medicated because the facility’s regulations passed due process muster. In Riggins v. Nevada, the Court held that inmates may be treated involuntarily where treatment is in the defendant’s medical interest and the defendant is dangerous to himself and others.  The court also stressed that forced medication should be a last resort and must strictly comport with due process requirements.  In this case, Riggins was awaiting trial for murder and robbery charges when he reported hearing voices and having issues with insomnia.  However, he did not want any antipsychotic drugs because they would affect his demeanor and mental state during trial.  The court did not uphold Riggins‘s forceful medication, as it violated his due process rights. In United States v. Sell, a dentist was charged with numerous counts of money laundering and fraud.  Dr. Sell had a history of mental illness, and the government obtained a subsequent indictment against him after he threatened the life of a witness and planned to kill an FBI agent, who were both involved in his case.  A federal magistrate judge ordered that Dr. Sell be sent to the U.S. Medical Center for Federal prisoners for up to four months for treatment to restore his competency.  The staff at the center believed they could restore Dr. Sell’s competency for trial by administering strong antipsychotic medications, but Dr. Sell declined medication to treat what was believed to be a delusional disorder.  He feared the serious side effects, some life-threatening, and refused the medication.  As a result, the staff forced Dr. Sell to take the medication.

The Sell Court rejected the possibility of medicating a defendant for the sole reason of rendering him competent for trial.

The issue in Sell was whether the government violated the Constitution when it administered antipsychotic drugs involuntarily to a mentally ill criminal defendant in order to render him competent to stand trial for a crime that is serious, but nonviolent.  Dr. Sell fought off forced medication for seven years and was finally deemed competent to enter into a plea agreement.  The Sell decision requires the government make specific showings before medication is forced on an incompetent defendant.  It rejects the possibility of medicating a defendant for the sole reason of rendering him competent for trial. In United States v. Dillon (pdf),the defendant, Simon Dillon, had a history of mental illness that included multiple periods of hospitalization.  Dillon made threats to the President, one involving an email he sent to a Secret Service agent while located only three blocks from the White House.  The D.C. Mental Health Commission recommended outpatient civil commitment, and, on January 13, 2012, a grand jury indicted Dillon.  He was then arrested and turned over to the care of the Attorney General.  Dillon’s competency was then evaluated on three different occasions with mixed results.  The diagnoses ranged from Schizophrenia, Paranoid Type with competency to stand trial to Delusional Disorder, Grandiose Type without competency to stand trial.

The Dillon opinion uses the dangerousness of the crime charged as grounds for the government to proceed with the prosecution, reasoning that a trial would be the only way to determine Dillon’s guilt beyond a reasonable doubt.

The opinion speaks of the dangerousness of the crime charged against Dillon and uses it as grounds for the government to proceed with the prosecution, reasoning that a trial will be the only way to determine Dillon’s guilt beyond a reasonable doubt.  The trial was pertinent in determining the extent of Dillon’s dangerousness and threat to the President. Therefore, Dillon’s competency could be restored with involuntary medication so that he could stand trial. The District Court used the test articulated in Sell v. United States to determine that the Government had a prosecutorial interest in medicating Dillon against his will so that he could stand trial.  This test allows the Government to involuntary administer anti-psychotic drugs to restore a defendant’s competence under rare circumstances if the Government is able to show that it has an “important” interest in the prosecution that is undiminished by special circumstances and that the medication will “significantly further” this important interest.  An important interest in the prosecution depends upon whether the crime is serious, and special circumstances involve an extended period of pretrial detention or potentially lengthy civil confinement. The Constitution protects a person’s liberty to refuse such mind-altering drugs.  It is questionable whether the government is infringing on this right by using factors that may be indeterminate in deciding whether to take away a defendant’s right to refuse medication. The Court recognizes that requiring a person to take unwanted psychotropic medication is a deprivation of such a liberty interest protected by the Due Process Clause and cites the Harper case, which held an individual “possesses a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs.”  It is difficult to say that a significant showing has been made regarding the Government’s interest when, as in Dillon’s case, there are conflicting diagnoses of his disorder and his competence to stand trial.