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Forced medication of criminal defendants and loss of inmates’ bodily autonomy

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1975’s groundbreaking One Flew Over the Cuckoo’s Nest film highlighted the dangers of forced mental institutionalization, forced medication, forced electroshock therapy, and forced lobotomies (I question whether lobotomies can ever do more good than harm).

Whether or not influenced by public outcries following Cuckoo’s Nest, around that time, state governments began releasing huge waves of previously-forced mental institution patients. Such a transition was certain not to be smooth.

Inmates held pretrial and post-conviction are heavily at the medical mercy of the jail and prison system. Those in deep need of their prescription medicine often are without it for substantial lengths of time after initially being arrested. Those who spent substantial time on the streets finding the right doctors no longer have access to their chosen physicians. Those who have found relief from such lawful non-drug remedies as herbs, certain foods, and vitamins will have serious problems accessing them while incarcerated.

Inmates lose enough privacy by using toilets and showers that are with little or no privacy, and likely often with questionable cleanliness at best. They lose bodily autonomy by being required to give random urine tests. After they have contact visits with lawyers and others, they are required to disrobe and be searched, lest their lawyer gave them a rock of crack or other contraband to hide in their underwear or cram up their anus. Daily government efforts at control, control, control are what inmates face.

Inmates who are a few or many sandwiches short of a picnic are often at risk of deteriorating even further in prison. Inmates who did not exhibit many or any delusions before entering incarceration may exhibit them while incarcerated; for some, their delusions might provide a much-preferred alternative to the reality of incarceration.

What happens when an inmate is so delusional that s/he is incompetent to stand trial? No trial may take place until a criminal defendant is competent to stand trial. Sell v. United States, 539 U.S. 166  (2003). Fortunately, at least for nonviolent crimes, the Supreme Court has set forth substantial safeguards before a criminal defendant may be forcibly medicated to render him or her competent to stand trial. Id.

In that regard, today, the Fourth Circuit ruled 2-1 against a District Court order allowing the forced medication of a woman charged with credit card fraud and identity theft. U.S. v. White, ___ F.3d ___ (4th Cir., Sept. 22, 2010).  Without medication, Defendant Kimberly White is too delusional to stand trial. However, it is not clear whether medication will even make her competent to stand trial. Id. In overturning the trial court’s order allowing forced medication of Ms. White, the Fourth Circuit concluded:

If we authorize the government to forcibly medicate White, an all-too-common, non-violent, long-detained defendant, in a case in which several factors strongly militate against forced medication, it would risk making "routine" the kind of drastic resort to forced medication for restoring competency that the Supreme Court gave no hint of approving in Sell. To the contrary, we think the Supreme Court intended to pay more than lip service to the imperative of individual liberty in its admonishment that forced medication is constitutionally permissible in "limited circumstances." Id. at 169. We decline to start down a path that would essentially permit the government to forcibly medicate any and every defendant deemed incompetent to stand trial, no matter how little public good or benefit will be achieved in doing so. 


Our society has too many people who all too quickly turn to pills with risky side effects, injections and surgery to address physical and mental ailments, rather than emphasizing a holistic approach that addresses how people treat one another; proper diet, rest and exercise; meditation, yoga, and other activities that can help people transcend seemingly insurmountable life obstacles; and other lifestyle and societal changes that focus on the cause of people’s ailments rather than merely at the roots.