Sell v. United States, 539 U.S. 166 (2003), is a decision in which the United States Supreme Court imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the sole purpose of making them competent and able to be tried. Specifically, the court held that lower courts could do so only under limited circumstances in which specified criteria had been met. In the case of Charles Sell, since the lower court had failed to determine that all the appropriate criteria for court-ordered forcible treatment had been met, the order to forcibly medicate the defendant was reversed.[1]
Previously, in Washington v. Harper,[2] the Supreme Court made clear that the forced medication of inmates with mental disorders could be ordered only when the inmate was a danger to themselves or others and when the medication is in the inmate's own best interests. In addition, courts must first consider "alternative, less intrusive means" before resorting to the involuntary administration of psychotropic medication.[2][1]
Using the framework set forth in Riggins v. Nevada,[3] the Court emphasized that an individual has a constitutionally protected "interest in avoiding involuntary administration of antipsychotic drugs" and this interest is one that only an "essential" or "overriding" state interest might overcome.[1]
Facts of the case
In 1997, Charles Thomas Sell, a St. Louis dentist with no prior history of criminal behavior, was charged with fifty-six counts of mail fraud, six counts of Medicaid fraud, and one count of money-laundering.[1] That year a federal judge found Sell competent to stand trial and released him on bail. However, Sell's mental status deteriorated while he was on bail, and his bail was revoked in 1998. Also in 1998, on the basis of a videotape provided by an undercover agent, Sell was charged with one count of conspiring to commit the attempted murder of the Federal Bureau of Investigation officer arresting him.[1] The agent later interviewed Sell in jail, and by questioning got him to say something about hiring a hit man.[4] In early 1999 Sell requested a competency hearing before standing trial for the fraud and attempted murder charges.[5]
Sell was given a competency evaluation by the United States Medical Center for Federal Prisoners (Medical Center), and in 1999 was found incompetent to stand trial. Sell was ordered to be hospitalized to determine whether he would be able to become competent so as to allow his trial to proceed. While in the hospital, Sell refused to take the antipsychotic medication prescribed by the Medical Center staff. The Medical Center sought to involuntarily medicate Sell. On June 9, 1999, an administrative hearing was held before a medical hearing officer who concluded that antipsychotic medication was the treatment of choice based on the fact that Dr. Sell's "delusional thinking could make him dangerous." Sell filed a court challenge to stop the hospital's decision to give him the drug involuntarily.[1]
The question of whether the drug could be administered involuntarily was the subject of several other hearings. In August 2000 the magistrate found that Sell was a danger to himself and others, authorized Sell to be forcibly medicated on the grounds that only medication would reduce his dangerousness, that any serious side effects could be treated, that the benefits to Sell were greater than the risks, and that the medication were substantially likely to restore Sell's competence.[1]
In 2001, Sell appealed on certiorari to the Federal District Court which, while reversing the federal magistrate's finding of dangerousness, upheld the order of forced medication on the grounds that it was necessary to restore Sell's competency to stand trial. The Eighth Circuit Court of Appeals affirmed the lower court's decision in a divided vote.[1] Sell's attorney pointed out that Sell had already been incarcerated for a longer period of time than if he were convicted for the offenses as charged.[4]
Although the Supreme Court upheld two aspects of the appeal, it ultimately vacated and remanded on the question of the petitioner's dangerousness.
Held
In a divided opinion (6-3), the Court held that the Constitution allows the Federal Government to administer antipsychotic drugs, even against the defendant's will, in limited circumstances as decided previously in Washington v. Harper and Riggins v. Nevada. It affirmed that involuntary administration for the purposes of restoring a defendant's competency to stand trial can be an appropriate means of acting in the state's interest to bring to trial defendants who are charged with serious crimes, overriding the defendant's right to refuse forced medication. However, the court outlined specific criteria which must be satisfied to justify involuntary medication. This framework was outlined in Riggins v. Nevada.[1]
An important government issue must be at stake and only a case by case inquiry can determine whether the government's interest is mitigated by the possibility of a long civil commitment for the treatment of the mental illness or by the fact that long periods of confinement have already been served, as this would be subtracted from any criminal sentence.
There must be a substantial probability that the medication will enable the defendant to become competent without substantial undermining side effects.
The medication must be necessary to restore the defendant's competency, with no alternative, less intrusive procedures available that would produce the same results.
[T]he Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.[1]
Held
The Supreme Court held that the Eighth Circuit Court of Appeals erred in approving the lower court's order to allow forced medication to restore Sell's competence to stand trial because the original decisions of the hospital and the judge were based on an assessment of Sell's dangerousness. Since the experts testifying at the hearings focused mainly on the issue of dangerousness and not on Sell's trial competence, there was not enough evidence in the court record regarding the possible effect of the medication on Sell's ability to obtain a fair trial.
Vacated and remanded
In examining the lower courts' findings, the Court found no evidence that Sell was dangerous, so the Court assumed that he was not. Determining that the findings of the District Court and Court of Appeals did not satisfy the criteria for involuntary medication, the Court vacated the appellate court's judgment.
Summary
The Court in its decision wrote that the standards it outlined will allow involuntary medication for the sole purpose of rendering the defendant competent to stand trial only in rare instances. The standard implies that a court must find that important governmental interests are at stake and that its interest in bringing the accused to trial for serious crimes is important enough to override constitutional issues, and that the forced medication will not significantly interfere with the defense or have untoward side effects. Therefore, in each case the facts and circumstances must be considered individually, balancing the government's responsibility to ensure timely prosecution with an equal interest in making sure a defendant obtains a fair trial. The court must weigh these factors and decide if forced medication will significantly further or hinder these conflicting interests of the state.
Significance
The Supreme Court laid down four criteria for cases involving the involuntary administration of medication to an incompetent pretrial defendant:[7]
Did the defendant commit a serious crime?
Is there a substantial likelihood that involuntary medication will restore the defendant's competence and do so without causing side effects that will significantly interfere with the defendant's ability to assist counsel?
Is involuntary medication the least intrusive treatment for restoration of competence?
Is the proposed treatment medically appropriate?
It is unknown in how many cases involuntary administration will now be justified, and any procedure outlined by the Court will require the government to submit proof on all the criteria outlined by the court. Beyond the federal situation, any constitutional ruling will apply to all criminal proceedings, state as well as federal.[5] However, although this decision possibly affects only a small percentage of trials, it seems to add weight to a growing acceptance of the belief that government can override the constitutional rights of self-determination on medical matters.[8] The case potentially could have addressed a more serious question of whether governmental manipulation of an individual's mental state through psychotropic drug administration is based on false assumptions of what makes up a person's individuality. The court chose to sidestep this issue.[8]
However, others disagreed, arguing that the strict limits imposed by the Supreme Court on involuntary medication meant that the involuntary medication of a non-dangerous defendant would be rare, especially since government's "important" interest in bringing the defendant to trial must be unattainable by alternative, less invasive means.[9]
At the very least however, the criteria set forth by the court will ensure that the lower courts considering the issue of forced medication must determine why it is medically appropriate to force drug an individual who is not dangerous and furthermore is competent to make up his own mind about treatment.[10]
Subsequent developments
In 2004, Sell was found competent to stand trial and trial was scheduled. A week before the trial was to begin, the prosecution and defense claimed that he was mentally unfit for trial and the trial was discontinued.[10]
On April 18, 2005, Sell pleaded no contest to federal charges of fraud and conspiracy to kill a federal agent, after serving eight years without trial in federal prison. The U.S. District Judge sentenced him to time served, six months in a halfway house and three years on parole.[4]
The insanity defense, also known as the mental disorder defense, is an affirmative defense by excuse in a criminal case, arguing that the defendant is not responsible for their actions due to a psychiatric disease at the time of the criminal act. This is contrasted with an excuse of provocation, in which the defendant is responsible, but the responsibility is lessened due to a temporary mental state. It is also contrasted with the justification of self defense or with the mitigation of imperfect self-defense. The insanity defense is also contrasted with a finding that a defendant cannot stand trial in a criminal case because a mental disease prevents them from effectively assisting counsel, from a civil finding in trusts and estates where a will is nullified because it was made when a mental disorder prevented a testator from recognizing the natural objects of their bounty, and from involuntary civil commitment to a mental institution, when anyone is found to be gravely disabled or to be a danger to themself or to others.
Forensic psychiatry is a subspeciality of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment." A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment, such as medications and psychotherapy, to criminals.
In United States and Canadian law, competence concerns the mental capacity of an individual to participate in legal proceedings or transactions, and the mental condition a person must have to be responsible for his or her decisions or acts. Competence is an attribute that is decision-specific. Depending on various factors which typically revolve around mental function integrity, an individual may or may not be competent to make a particular medical decision, a particular contractual agreement, to execute an effective deed to real property, or to execute a will having certain terms.
Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.
In the United States criminal justice system, a competency evaluation is an assessment of the ability of a defendant to understand and rationally participate in a court process.
Dusky v. United States, 362 U.S. 402 (1960), was a landmark United States Supreme Court case in which the Court affirmed a defendant's right to have a competency evaluation before proceeding to trial. The Court outlined the basic standards for determining competency.
Washington v. Harper, 494 U.S. 210 (1990), was a United States Supreme Court case in which an incarcerated inmate sued the state of Washington over the issue of involuntary medication, specifically antipsychotic medication.
Foucha v. Louisiana, 504 U.S. 71 (1992), was a U.S. Supreme Court case in which the court addressed the criteria for the continued commitment of an individual who had been found not guilty by reason of insanity. The individual remained involuntarily confined on the justification that he was potentially dangerous even though he no longer suffered from the mental illness that served as a basis for his original commitment.
Jackson v. Indiana, 406 U.S. 715 (1972), was a landmark decision of the United States Supreme Court that determined a U.S. state violated due process by involuntarily committing a criminal defendant for an indefinite period of time solely on the basis of his permanent incompetency to stand trial on the charges filed against him.
Perry v. Louisiana, 498 U.S. 38 (1990), was a United States Supreme Court case over the legality of forcibly medicating a death row inmate with a mental disorder, to render him competent to be executed.
Riggins v. Nevada, 504 U.S. 127 (1992), is a U.S. Supreme Court case in which the court decided whether a mentally ill person can be forced to take antipsychotic medication while they are on trial to allow the state to make sure they remain competent during the trial.
Frendak v. United States, 408 A.2d 364 is a landmark case in which District of Columbia Court of Appeals decided that a judge could not impose an insanity defense over the defendant's objections.
Godinez v. Moran, 509 U.S. 389 (1993), was a landmark decision in which the U.S. Supreme Court ruled that if a defendant was competent to stand trial, they were automatically competent to plead guilty, and thereby waive the panoply of trial rights, including the right to counsel.
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit considered whether a person diagnosed with mental illness committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency conditions.
Drope v. Missouri, 420 U.S. 162 (1975), was a United States Supreme Court case in which the Court held a Missouri trial court deprived a defendant of due process by failing to order a competency examination after he was hospitalized following an attempted suicide and as a result missed a portion of his trial for a capital offense.
Cooper v. Oklahoma, 517 U.S. 348 (1996), was a United States Supreme Court case in which the Court reversed an Oklahoma court decision holding that a defendant is presumed to be competent to stand trial unless he proves otherwise by the second highest legal standard of proof, that of clear and convincing evidence, ruling that to be unconstitutional. The court said the defendant's Fourteenth Amendment rights to due process were violated.
Indiana v. Edwards, 554 U.S. 164 (2008), was a United States Supreme Court case in which the Court held that the standard for competency to stand trial was not linked to the standard for competency to represent oneself.
United States federal laws governing offenders with mental diseases or defects provide for the evaluation and handling of defendants who are suspected of having mental diseases or defects. The laws were completely revamped by the Insanity Defense Reform Act in the wake of the John Hinckley Jr. verdict.
This disability rights timeline lists events relating to the civil rights of people with disabilities in the United States of America, including court decisions, the passage of legislation, activists' actions, significant abuses of people with disabilities, and the founding of various organizations. Although the disability rights movement itself began in the 1960s, advocacy for the rights of people with disabilities started much earlier and continues to the present.
Eleanor Riese (1949–1999) was an American patient who sued a hospital for her right to refuse antipsychotic medication. The court decision significantly changed the approach to psychiatric patients.
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