After recovering from injuries he suffered when police returned fire, Mr. Weston was evaluated by a forensic psychiatrist and determined incompetent to stand trial.1 He was subsequently transferred to a federal prison hospital in Butner, North Carolina, for the purpose of receiving treatment designed to restore his competence to stand trial. While at Butner, however, Mr. Weston refused to take antipsychotic medication, and his defense attorneys filed court papers arguing that forcing him to do so would violate his constitutional right to refuse treatment.
In late May, a hearing was held in the federal district court to determine whether Mr. Weston should be forcibly medicated. At the hearing, his attorneys informed U.S. District Court Judge Emmet Sullivan that, while Mr. Weston would not consent to taking medication, he would comply with a court order to do so if one were issued. Judge Sullivan has not yet issued his ruling in this matter.
The U.S. Supreme Court addressed the issue of whether criminal defendants awaiting trial have the right to refuse antipsychotic drugs in Riggins v. Nevada.2 In that case, the defendant, David Riggins, filed a motion seeking discontinuation of his antipsychotic medications after being found competent to stand trial. He argued that the effects of these drugs on his demeanor and mental state during trial would deny him due process.3 He further argued that because he was planning to offer an insanity defense at trial, he had a right to demonstrate to jurors his "true mental state" at the time of the crime.4 The District Court denied Riggins' motion to terminate medication. Riggins was subsequently tried, convicted and sentenced to death. The Nevada Supreme Court affirmed both the conviction and death sentence.5
The Supreme Court reversed the conviction and remanded the case back to the trial court, holding that criminal defendants awaiting trial have a qualified right to refuse treatment under the Due Process Clause of the Fourteenth Amendment. The Court referenced an earlier decision, Washington v. Harper, that characterized the involuntary administration of antipsychotic medications to a convicted prisoner as "a substantial interference with that person's liberty."6 This right, the Riggins Court held, is as least as strong for "persons the State detains for trial."7
However, the majority in Riggins emphasized that the right of criminal detainees to refuse medication is not absolute. It suggested that this right may be overridden if the State demonstrates that the treatment is medically appropriate and that no less intrusive alternatives are available to address the safety of the detainee or others.8 It further suggested that this right may be overridden if the State proves "that it could not obtain an adjudication of … guilt or innocence by using less intrusive means."9
The Supreme Court appeared to be particularly influenced by three factors in holding that prisoners awaiting trial have a right to refuse medication. First, the Court expressed concerns about the potentially serious side effects of antipsychotic medications: "While the therapeutic benefits of antipsychotic drugs are well documented, it is also true that the drugs can have serious, even fatal, side effects."10
The recent emergence of antipsychotic medications with fewer negative side effects may make this less of a concern today. However, since these newer medications are more expensive, they are frequently unavailable to those persons who are incarcerated. Moreover, staff in these facilities may not be adequately trained to recognize and respond appropriately to inmates with mental illnesses experiencing the side effects of antipsychotic medications.
Second, the Court appeared concerned that antipsychotic medications could impact negatively on Riggins' ability to participate meaningfully in his own defense. This concern was based, in part, on the heavy dose of Mellaril administered to Riggins - 800 milligrams per day. The American Psychiatric Association suggested in an amicus brief that this dosage "may be severe enough … to effect thought processes."11
Although perhaps valid, the context in which this issue arose in Riggins is quite different from the Weston case. Weston's lawyers may not be fearful that the potential side effects of medication will hamper his ability to participate meaningfully in his own defense. Rather, they may be more concerned that appropriate medication will sufficiently alleviate the symptoms of his illness to render him competent to stand trial. Understandably, they do not want to hasten the process of making him competent to stand trial, particularly in light of the prosecution's unwillingness to state thus far that it will not push for the death penalty in this case.
A third concern expressed by the Riggins Court pertains to the impact of medication on the demeanor of the defendant at trial. This is of particular concern in cases like Weston, where defendants are likely to assert the insanity defense. Juries in these cases are instructed to base their determinations of guilt or innocence on the state of mind of defendants at the time of their crimes. However, this is difficult to do, since a number of years may pass between the time the crime occurred and the time the case actually goes to trial. This is particularly problematic in cases in which the defendant has received treatment in the interim, because his or her state of mind or demeanor at trial may be very different than at the time of the crime. Thus juries may never fully appreciate the nature and symptoms of a defendant's severe mental illness at the time the crime was committed.
In the Weston case, there is little doubt that the defendant suffers from a longstanding severe mental illness and was very likely psychotic at the time of the crime. Hence, complicated, protracted legal maneuvering by the parties are contrary to the interests of all concerned. Mr. Weston is in desperate need of medication and treatment for his severe schizophrenia. His lawyers understand this, but probably feel that they have no alternative but to assert his right to refuse treatment, as they do not want to risk subjecting Mr. Weston to a trial so long as the death penalty remains a possible outcome. In view of Mr. Weston's obviously dangerous propensities, the government's objective, quite understandably, is to ensure that he is removed from society for a long time so that he cannot harm anyone else.
These respective objectives - psychiatric treatment for Mr. Weston and removal from the community - are quite compatible. The obstacles to swift resolution of this case relate to traditional criminal procedures. Though they are designed to protect criminal defendants, these procedures, ironically, will hurt the defendant, Mr. Weston, in this case. Since he is obviously very psychotic, it is in his best medical interest to receive swift treatment for his mental illness. However, so long as it remains unclear whether the prosecution will push for the death penalty, swift treatment may not be in his best legal interest.
Ultimately, the answer to the dilemma in this case may lie in the Court taking a more active role in facilitating a speedy resolution to the impasse. One way this could be accomplished would be through the assumption of a more active role by the presiding judge. A pre-trial conference or hearing in his chambers could be arranged to discuss the issues and possible solutions that would satisfy the objectives of both parties. This solution must include long-term treatment for Mr. Weston in a secure treatment facility, which would ensure that he is removed from society while guaranteeing that he receives the treatment he needs. Long delays in resolving this case will serve only to prolong Mr. Weston's suffering, as well as the agony experienced by the families of his victims.
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