To stand trial, defendants can be medicated by force

The US government can forcibly administer mind-altering drugs to render criminal defendants competent to stand trial, but only under certain limited circumstances.

In a case with potential implications for those opposed to conventional medical care, the US Supreme Court ruled 6 to 3 Monday that the government's interest in bringing defendants to trial outweighs an individual's decision to be free from forced medication.

The high court declined to find that individuals possess a fundamental right under the Constitution to reject forced medication. The decision doesn't discuss this issue. Instead, the majority concluded that the government has the power to take action when a defendant is "mentally ill" and facing "serious criminal charges."

In the majority opinion, Justice Stephen Breyer established a new legal standard that substantially narrows the permissible circumstances for such government action. "This standard will permit involuntary administration of drugs solely for trial competence purposes in certain instances. But those instances may be rare," Justice Breyer writes.

The high court outlined four conditions that a court must meet to approve the forcible medication of a defendant. First, the court must find important government interests are at stake. Second, it must conclude that involuntary medication will significantly further those government interests. Third, the court must conclude that involuntary medication is necessary to further those interests. And fourth, it must conclude that administration of the drugs is medically appropriate in light of the patient's best medical interests.

The justices also noted that a court must find administration of the drugs is substantially unlikely to have side effects that will significantly interfere with a defendant's ability to assist in his or her defense at trial.

Breyer was joined in the majority opinion by Chief Justice William Rehnquist and Justices John Paul Stevens, Anthony Kennedy, David Souter, and Ruth Bader Ginsburg.

The decision comes in the case of a St. Louis dentist, Charles Sell. He was charged in 1997 with running a Medicaid insurance fraud scheme. Dr. Sell has been diagnosed with a mental illness, called delusional disorder - persecutory type, which has rendered him incompetent to stand trial.

Medical experts hired by the government say that certain antipsychotic drugs could restore Sell's competence and permit him to stand trial. But Sell's lawyer says Sell has had bad experiences with side effects from such drugs and refuses to take them.

The appeals court in Sell's case ordered that he be forcibly medicated.

The Supreme Court's decision vacates that ruling and remands the case back to the lower courts to apply the new, tougher standards.

Sell's lawyer, Barry Short, says the decision is a clear victory. "It is going to be much more difficult for the government to ever be able to force medication on somebody who doesn't want it," he says.

Sell's case is unique in that the court determined he was legally incompetent to stand trial but he was nonetheless competent to make his own medical decisions. In addition, the appeals court ruled that he did not pose a danger to himself and others.

In the high court's ruling, the justices say that assuming that Sell is not dangerous, the appeals court was wrong to approve forced medication solely to render Sell competent to stand trial.

The Sell case had raised concerns by civil libertarians who were worried about the possible broader implications of the case. Some questioned whether the same legal approach might be used to justify requirements by a local school board that unruly children take Ritalin as a condition of attending public school. Others questioned whether criminal defendants have a First Amendment right to think and act in a certain way without being subjected to the influence of antipsychotic drugs.

The high court dodged these broader issues by writing a narrow decision.

In a dissent, Justice Antonin Scalia says he is concerned that the decision may create grounds for certain defendants to delay their trials. "Monday's narrow holding will allow criminal defendants in petitioner's position to engage in opportunistic behavior," he writes. "They can, for example, voluntarily take their medication until halfway through trial, then abruptly refuse and demand an appeal."

It remains unclear what will happen to Sell, but one outcome is that he could be ordered released as a result of the long time he has spent in pretrial custody. Sell has been held for almost six years. He has already been in federal custody longer than the sentence he would have received under federal-sentencing guidelines if convicted of the fraud charges.

• Linda Feldmann contributed to this report.