Competency evaluations and restoration efforts for defendents
Circumstances in which prescribed medication may be administered involuntarily
Legal and scientific sources of authority
Ethical and practical sources of authority
Recommendations for practice
Psychotropic medications are often crucial in restoring criminal defendants to competency to stand trial. However, some defendants committed for competency evaluations or restoration refuse medications. Thus, psychiatric professionals who work in jails and secure hospitals, and even in community mental health settings, may encounter questions about involuntarily medicating patients who are incompetent for trial.
Legal sources of authority
Competency to stand trial is one of several competency issues within the criminal law. A series of cases decided by the US Supreme Court provides guidance on several circumstances in which a patient incompetent for trial may be involuntarily medicated (local jurisdictions may have slightly different—typically stricter—requirements than the available US Supreme Court precedent).
There are 2 particular circumstances in which prescribed medication may be administered involuntarily; both assume that voluntary administration has been declined. The first is when the patient is dangerous to himself or others. The second, described in Sell v United States,1 concerns a patient (such as the federal defendant at issue in Sell) who refuses medications in the face of serious charges, but is neither dangerous nor incompetent to make treatment decisions. The Supreme Court held that involuntary medication for such a patient (ie, solely for restoration) is only allowable when:
1) The medication is substantially likely to restore competence.
2) The medication is substantially unlikely to have adverse effects that will significantly infringe on the defendant’s trial rights (eg, demeanor relevant to one’s ability to testify and not prejudice the fact finder against him or her in the presentation of an effective defense; cognitive functioning as relevant to following the proceedings and consulting with counsel).
3) Less intrusive alternatives are substantially unlikely to achieve restoration.
4) Important prosecutorial interests are at stake (eg, seriousness of the alleged offense, blameworthiness considering the defendant’s prior criminal record, and need for confinement to protect public safety); in both scenarios, the medication must also be in the patient’s medical interest.
Dr. Heilbrun is Professor, Department of Psychology, Drexel University, Philadelphia, PA. Dr. King is Assistant Professor, Department of Psychology, Montclair State University, Monclair, NJ.
The authors report no conflicts of interest concerning the subject matter of this article.
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