The Pre-Sell Medication Controversy: Restoring Competency at the End of the 20th Century

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The Pre-Sell Medication Controversy: Restoring Competency at the End of the 20th Century

In 2003, the United States Supreme Court issued a ruling concerning the involuntary medication of defendants who had been adjudicated as incompetent to stand trial (Sell v. U.S., 2003). The Court heard the case to resolve the conflicting rulings of several U.S. Circuit Courts of Appeal, but the Supreme Court's ruling itself has been controversial and subject to a variety of interpretations. Those varying interpretations, contained in subsequent appeals court decisions, and their effects on clinical practice, are addressed in other articles in this issue. This article will attempt to describe the context in which the Court undertook this ruling and the progression of cases involving the due process rights of psychiatric patients that set the stage for this ruling. It is not an attempt at legal scholarship regarding the conflict between individual rights and governmental interests. For an excellent example of such scholarship, see Morse (2003). Rather, it takes an historical perspective to describe the development of the diverging viewpoints in the last part of the 20th Century that necessitated the Supreme Court taking up the issue.

The development of patient's rights

Since at least the middle of the 19th century, relying on the principle of parens patriae and later their "police power," states were able to commit psychiatric patients to hospitals for the protection of the patient or society or because the patient was incapable of acting in his or her own welfare (Mrad & Nabors, 2007). States' commitment laws gave little consideration to the rights of committed patients, and as late as 1960 the Iowa Supreme Court held that the Due Process Clause of the Fourteenth Amendment did not apply to civil commitment because it was not such a deprivation of liberty (Perlin, 1989). The following decade ushered in an era in which the civil rights and liberties of many minorities, including psychiatric patients, were reexamined by society in general and particularly by the U.S. Supreme Court.

The longstanding denial of due process rights to committed psychiatric patients was drastically altered in 1972. That year, the U.S. Supreme Court heard Humphrey v. Cady (1972), the case of a Wisconsin prisoner who, in lieu of a sentence, was indefinitely committed under that state's Sex Crimes Act. He was not afforded a jury determination as would have occurred in commitment proceedings under the state's Mental Health Act. In the decision reversing the commitment, Justice Marshall referred to civil commitment as "a massive curtailment of liberty" (p. 509), heralding a broader application of the Due Process Clause, one that would include individuals who had been civilly committed.

That same year, the U.S. Supreme Court decided another involuntary commitment case that also originated in the criminal justice system, Jackson v. Indiana (1972). Although this case is best known for establishing limitations on the duration of commitments for competency restoration, it also established an important more general due proc...

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