Forced medication: When does it violate rights?

A St. Louis dentist accused of insurance and Medicaid fraud is fighting an effort by the US government to forcibly inject him with antipsychotic drugs, to render him competent to stand trial.

For nearly four years, Charles Thomas Sell has fought a losing court battle to avoid the unwanted medication. He says it is a form of government-authorized mind control in violation of his First Amendment right to freedom of thought.

Monday, his case arrives at the US Supreme Court, where the justices must decide whether the government's interest in prosecuting Dr. Sell outweighs Sell's interest in being free from forced medication.

The case holds major implications for individual liberty, should the justices grant the government broad powers to overrule personal decisions rejecting medical treatment. It could, for example, enable local boards of education to force problem schoolchildren to take Ritalin as a condition of attending public school, or empower health officials to mandate blanket anthrax vaccinations regardless of personal objections.

In even broader terms, the case could affect the right of certain religious groups to practice a reliance on prayer rather than on conventional medicine and medical technology endorsed by the government and its chosen experts.

"I have a God-given right not to have [my brain] altered by the government's antipsychotic, psychotropic medication," Sell says in court filings. The dentist, who has a history of mental illness, compares the effects of such drugs to enduring a lobotomy.

Sell's case comes to the high court from the Eighth US Circuit Court of Appeals in St. Louis, which ruled in a similar case last month that Charles Singleton, an Arkansas death-row inmate who is mentally ill, could be involuntarily medicated to render him competent to be executed.

What distinguishes the Sell case, his lawyers say, is that the dentist has not been convicted of a crime. Rather, he has merely been accused of violating the law. In addition, the crimes for which he has been charged are less serious than murder, they say.

Government lawyers insist that Sell will be better off in a medicated state. "Antipsychotic medication is likely to enhance, rather than suppress, a psychotic or delusional patient's ability to think and communicate," says US Solicitor General Theodore Olson in his brief to the court.

"This court has made clear that an individual has a significant liberty interest in avoiding the involuntary administration of antipsychotic medication. Such an interest, however, is not absolute," Mr. Olson continues. "In circumstances where the government's interest is sufficiently weighty, [the individual's interest may be] subordinated to the greater needs of society."

Critics of the government's position see shades of "1984," the novel by George Orwell that warned of brainwashing and other inhumane abuses of dictatorial government aided by intrusive technology.

"We are entering a time in history when many of these issues are becoming real. They aren't just Orwellian fiction," says Richard Glen Boire of the Center for Cognitive Liberty & Ethics in Davis, Calif.

"If a person has a right to speak freely and the government is not permitted to censor your speech or gag you, what we have in the Sell case is more dangerous and debilitating," Mr. Boire says. "They are going to change the way you think which will necessarily affect what you are capable of expressing."

The case against Sell began in 1997 when he was charged with making false statements in an alleged $400,000 to $1 million healthcare insurance fraud.

Sell has been held in pretrial detention for nearly five years, much of it in a federal prison mental-health facility. The period of detention is already longer than the maximum sentence he would likely receive should he be convicted of the alleged healthcare fraud.

Generally, defendants deemed mentally ill can be held in a mental-health facility until they are competent to stand trial. In Sell's case, there is a disagreement about how best to treat his mental illness.

Government experts suggest that certain types of medication might quickly render him competent for trial. But Sell says the drugs come with dangerous side effects. Sell's psychiatrist says he should be treated by placing him in a supportive atmosphere and administering only drugs that are acceptable to the patient.

Government psychologists say that a more rigorous application of drugs holds a higher promise of success.

In past cases, Sell's supporters say, such forced-medication orders have come only after a finding that the individual represents a danger to himself or others, or that the individual is no longer competent to make his or her own medical decisions. No such findings have been made in the Sell case, they say.

The federal appeals court that last considered his case ruled 2 to 1 that the government had "an essential interest" in rendering Sell competent to bring him to trial. The panel also ruled that there was no less intrusive way to do it.

Some people see more fundamental issues in the case. "Government action that seeks to change a person's thinking, against his will, is deeply at odds with longstanding conceptions of constitutional liberty," says David Goldberg in a friend-of-the-court brief on behalf of the Drug Policy Alliance.

He continues, "If decisions concerning family, procreation, and child-rearing are 'fundamental' based on their nexus to 'personhood,' then similar protection for the individual's mental life - his personality - must follow a fortiori."