Forcible Medication and the Fourth Amendment: A New Framework for Protecting Nondangerous Mentally Ill Pretrial Detainees Against Unreasonable Governmental Intrusions into the Body

Comment by Rebekah W. Page

In June of 2003, the United States Supreme Court ruled in Sell v. United States that, in certain circumstances, the state may forcibly medicate a criminal defendant for the sole purpose of making him competent to stand trial. After resolving jurisdictional issues, the Sell Court weighed the private and government interests at stake under the Due Process Clause. This Comment will compare the Court's treatment of the issue of forced medication with its applications of the Fourth Amendment's Reasonableness Clause to governmental searches involving serious intrusions into the body. Analysis under both rubrics requires balancing of governmental and private interests, but the Fourth Amendment case law offers a wider range of contexts in which courts have evaluated the constitutionality of governmental invasions of the body. The lessons of this analysis should assist courts in analyzing forced medication cases after Sell, particularly in applying Sell's requirement of “medical appropriateness.”

Part II of this Comment will provide a brief description of the various antipsychotic medications and of traditional critiques of forcible administration. In describing the severity of forcible medication, this Part will address the problem of “synthetic sanity” and the possibility of serious and sometimes dangerous side effects resulting from both older (typical) and newer (atypical) antipsychotic medications. In Part III, this Comment will recount the facts and holding of Sell v. United States, focusing on the Court's four-step standard for forcible medication of criminal defendants in order to make them competent to stand trial. Part IV will compare the Court's Fourth Amendment case law to the issue of forcible medication and will show that forcible antipsychotic medication for government purposes closely resembles governmental actions that the Court has held unreasonable under the Fourth Amendment. This Comment will argue that whether the government is obtaining evidence from the body of a defendant or making a defendant competent to stand trial, the severity of the intrusion is of equal concern. Additionally, it will argue that the Sell Court's unnecessarily vague “medical appropriate-ness” prong is a specific instance in which Fourth Amendment analysis provides a new, stronger framework for evaluating governmental intrusions. The Court's Fourth Amendment doctrine indicates that the determination of “medical appropriateness” should be an entirely medical decision kept distinct from the government's goals for prosecuting crime.

Part V will argue that the Fourth Amendment's balance between governmental interests and private intrusions points toward a greater respect for bodily integrity in the analysis of forcible medication cases. Courts' applications of the Fourth Amendment balancing test show that it provides an equally accurate, yet more humane, framework for the forcible medication issue than does the due process balancing test courts traditionally apply. The Sell Court's ruling on the forcible medication issue turns on the “medical appropriateness” requirement, and this Comment will argue that the Fourth Amendment bodily intrusion case law necessitates that forcible medication have sound medical justifications independent of the purpose of making the defendant competent to stand trial.


About the Author

Rebekah W. Page. J.D. candidate 2005, Tulane University School of Law; B.A. 2002, Connecticut College.

Citation

79 Tul. L. Rev. 1065 (2005)