The term legal competence can e defined as one how has sufficient amount of ability and has both natural and legal qualifications. Competency can be utilized in several areas of law. With consideration to the legal aspect, competence refers to the minimal amount of mental, behavioral and cognitive ability to be given due consideration by the legal system. An incompetent individual is one who cannot assume a particular role that can be considered by the law (Bisbing, 1995). It is our right to accept or reject medical treatment depending on our intentions. There are several instances in which the concept of autonomy has been given great importance by the courts. The health provider could be held for battery if found doing anything without the due consent of the patient.
However, in the prisons, frequently innocent prisoners are forced into medical treatment in order to improve their mental functioning, so that they can undergo trial, and be competent enough to be prosecuted. Frequently, it is the right of the state to protect the people which clashes with the right of the prisoners. Prisoners may be declared incompetent through competency hearing procedure. The court may order indefinite assistance until the competency returns. The state may hasten up the process of regaining competency so that they could be prosecuted and even executed earlier. This may be considered completely unethical and unreasonable as it would directly clash with the human right. In this paper, I would be considering whether psychotropic medications should be permitted in prisons as a part of medical treatment to hasten the competence so as to enable a trial process and execution (Swedlow, 2008).
In the 1990 US Supereme Court case titled Washington V. Harper, the issue of providing treatment with psychotropic drugs to a prisoner who did not want such treatment was confronted. The state found that it was permitted to force the individual to take medications in order to treat the mental disorder. In this case, the court found that the defendant was a danger to himself and others due to his medical condition. The court expressed some concern of Harper of being forced into medical treatment and the risk of suffering from the adverse effects of the drug. However, in this case, it was well justified as to why the drugs needed to be administered. In the best interests of the patient, the court said that the physician would determine the needs to administer the drug and not the court. The Court would only pass a decree in this regard (Swedlow, 2008).
In another case Riggins vs. Nevada 1992, the court did not consider the fears of the defendant to undergo in volunteer treatment. The prisoner was worried about the effects of medications as it would adversely affect his trial procedure. The court refused to stop his medication as his psychiatric condition was a hazard to him and others. In another case titled United States V. Sell, the defendant has been convicted of frauds insurance accusations and is incompetent. They are faced with the question of restoring his competency.
There are several points which have to be noted in this case:
- Sell did not pose a hazard to himself or others
- Administration of antipsychotic medication was not going to definitely restore his competency
- Those better and newer antipsychotics have been developed having very few adverse effects and risks.
The defendant said that even though safer antipsychotics were available, the right to select a particular medication or treatment was still left with the patient himself. Hence the government had no hand in selecting which treatment could be forcibly administered to him. This was a fundamental right given to him under the constitution. In this case, a balance had to be made between the right to privacy and autonomy and the right of the government to bring the convicted to trial. The defendant also said that the newer antipsychotics still had certain side-effects and could pose a risk. Sell was also convicted of a non-violent crime, which gave him an upper hand (Kathy Swedlow, 2008).
An individual should not be subjected for criminal trial if he/she is unable to understand the nature of his/her crime, the objective of having such a criminal procedure against him/her, the goals of the counsel, etc. The counsel in such a case should preferable try to help him/her in their own defense. According to Blackstone, when a person in his sound memory commits a capital offense, and before being punished for it become a lunatic, then he should not be punished for his crime. This is because the individual is unable to understand the nature of his crime and the reason as to why he/she is being punished. Suppose if the criminal becomes mad after the pleading is done, he/she should still not be punished, as he cannot make a reasonable defense.
The statement by Blackstone is a common law principle that is frequently utilized in American Courts, to ensure that the case is fair. During the entire process of trial, the criminal should be able to meaningfully participate. As per the fundamental rights of the US, the criminal should be competent enough to understand the moral and philosophical system of justice. This can be followed in one of the US Supreme Court cases titled Pate vs. Robinson. In this case the right to a fair trial could be obstructed if the defendant’s right not to be trailed and sentenced when he/she is incompetent is going on. However, throughout the world the need for the defendant to be competent during the time of trial has constantly arisen. Several mental criteria are taken into consideration in order to determine the trial competency (Firestone, 1995).
Across the US, various states have tried to establish certain standards of mental states. These include ability to recollect past events, orientation of the place and time, etc. One of the tests proposed to determine competency of the individual for a fair trial was set in Dusky V. United States, in which the bare minimum standards were set. The individual should have sufficient ability to consult a lawyer and should be rational in comprehending the n nature of the case against him. However, due to the very nature of the test, frequently dispute and controversies regarding the defendant’s competency. Hence, many courts have tried to set up better criteria in order to determine the competency of the criminal. These include capacity to interact, testify, follow the proceedings, have reasonable amount of rational understanding, etc. In determining the competency, three stages are involved:-
The trigger stage – the defense, prosecution or the court can trigger incompetency issues during the trial. As a fundamental right, the defendant needs to be competent, and any the trial should not move on if the defendant is incompetent. This is a constitutional obligation. The court would appoint few mental health experts for psychiatric examination. One procedural and one substantive examination are conducted. If the defendant is found to be mentally incompetent, a psychiatric examination would automatically be done. An individual would be found incompetent to stand the trial in case evidence of incompetence, insanity, etc, are found.
Determination of sufficient evidence, by which a formal hearing can be conducted. During this stage, the physiatrist plays a very important role. It is important that the court takes into consideration the results of the psychiatric examination. Following the psychiatric examination, the court needs to provide judicial hearing regarding the incompetency of the defendant. The extent of incompetency needed to ensure that a hearing could be provided has not been determined properly by the courts. However, the constitutional standards need to be met to a reasonable extent.
The competency hearing – During the period of the trial, the competency hearing can be conducted at any time to ensure protection of the defendant. This is the fundamental right offered by the constitution. The prime witness for demonstrating the competency/incompetency of the defendant is the psychiatrist who is now termed as the ‘psychiatric witness’. He is the person who has initially evaluated the mental status of the defendant during the earlier stage. The normal trial has a lot of differences from a competency hearing. Both parties including the state and the defense can produce their won experts, witness and lay in order to determine the competency of the defendant. During the trial, the defendant can cross-examine other witnesses in the box and also has the right to counsel. The fifth to arbitration before a judge or a jury is absent, unlike in a normal trial. In the state courts the defendant has to prove his incompetency by preponderance of evidence, but in a federal court it is the prosecutor who has to prove that the defendant is competent.
In an incompetency hearing, the defendant’s right to invoke the privilege of self-incrimination is decreased. This was set forth by the case Estelle V. Smith, in which the defendant may not claim the privilege against self-incrimination so as to prevent the psychiatrist from acting as a witness for the defendant’s competency. According to the Fifth Amendment, it was confirmed that the privilege against self-incrimination may restrict disclosure of statements during the pretrial stages of competency hearing (Firestone, 1995).
A competency hearing is very valuable in ensuring a free and fair trial. Different laws and statues across the US states provide different rights and limitations regarding competency in the court trials. Previously, if a defendant was found to be incompetant during a trial, he was referred to a state institution, where he could regain competency so as to under trial. This could extend to almost an indefinite period. In the 1972 case, Jackson V. Indiana, the issue was regarding the indefinite commitment of the defendant in case they were found to be incompetent. The court said that the commitment period should not exceed for a reasonable period of time required to determine where there is a substantial probability the he will attain competency in the foreseeable future. The burden of demonstrating competency was the function of the state. The court would determine whether the defendant needs to be kept in custody for a reasonable period of time until they would attain competency or whether they need to be released (Firestone, 1995).
The competency delivered by antipsychotic medications is artificial competency. Such an individual having his competence restored through drugs would not have the same level of competence as before. An individual suffering from psychiatric disorder and who have been administered antipsychotic medications would still be having certain elaborate mental symptoms that are masked by the drugs. Antipsychotic medications administration and the presence of such masked symptoms would still be affecting the thinking capacity of the individual, mental processes, behavior, etc. In Sell V. US, the psychiatric experts provided that antipsychotic medications provided mental health was inauthentic and alien to the patient. It could be compared to other medications such as penicillin as in pneumonia.
Several organizations felt that such a comparison was problematic, as antipsychotic administration produced its effect when only being administered. Once the drug administration was seized, the symptoms returned, and the mental disorder surfaced again. The drugs are mainly administered in order to change the levels of certain chemicals such as neurotransmitters in the brain. The drugs can have a very beneficial effect over physical and mental health. However, the drugs can also have a negative effect. Some of these adverse-effects can be debilitating and can result in more serious disorders. The Court in Sell said that after the Higgins and the Riggs case, better and safer antipsychotic drugs have come out which could potentially change the manner by which the courts need to give a verdict.
Several issues need to be taken into consideration regarding antipsychotic drug administration:
- That forcing a drug to improve the mental state does not depend on the availability of safer and more efficient drugs
- That antipsychotic drugs change the manner in which the individual thinks and behaves and hence would be invoking First Amendment Concern. The outward expression of the inner thought processes may be seriously changed following administration of drugs. Hence, the very comprehension of the case, would be seriously altered (Kathy Swedlow, 2008).
The courts will not permit a justification that medications should be prescribed involuntarily as the individual is at a risk of harming oneself or others. The state may feel that they have the responsibility of carrying out a sentence at any costs, including the defendant refusing mental treatment. If the state is given a go-ahead in such cases, it clearly shows a defect lying in the American justice system. In the case Singleton V. Norris, the court said that an incompetent prisoner could be forcible medicated so that he regains competence and can be executed. The court found that Singleton’s right to refuse medication did not outweigh the state right to protect the general public. The defendant’s argument was rejected in this case. However, many people do feel that the prosecution system in the US is still rigid and needs to be altered in order to protect the rights of the incompetent defendant (Kathy Swedlow, 2008). In Singleton, the prisoner was found guilty of murder (provided by several eye witnesses). He was sentenced to death by the Court.
However, during his imprisonment he was found to be suffering from Schizophrenia. He often suffered from delusions and other mental symptoms. He had to be administered antipsychotic medications in order to prevent harm to self or others. This was justified through the Harper case (involuntary use of medications to prevent hazards to self or others). Singleton argued through petition that the restoring competency through forcible medication for a prisoner whose date of execution has already been set was illegal and no longer in the medical interests of the individual. The government went on to say that this was in the best interests of the state, and the individual had to be administered medications even though he did not intent to consume the same. There was no better way of meeting their goal, and evidence suggested that the medications utilized were appropriate in that particular situation.
According to the Court, when the execution punishment and the execution date have already been set, then it would not be unconstitutional to forcefully administer medications so as to restore competence. The court also did not consider the Louisinia rulings that people who have been sentenced not be forcible medicated so that they are able to regain competence (Kathy Swedlow, 2008 & Howard V. Zonana, 2003).
From an ethical standpoint, there seems to be a lot of conflicting interests. The state has the duty to protect the safety of the people, and on the other hand, the personal interests and the life of the insane defendant lie. I do think that if the defendant can be providing competent during the period of the crime, he should be punished for his ill-doings. The mental act of harming others is present for which he needs to be sentenced to death. The state would have to protect the safety of other and hence requires the execution to go through. On the other hand, suppose the defendant is found incompetent later after being sentenced to execution, and becomes incompetent due to the mental condition, then the state has to ensure that he is able to regain competence through standard medical treatment. During execution, the sentenced person needs to be competent to understand the entire process.
I would consider that outcome of the Singleton case and the Harper case, some of the basic guidelines by which the issue of forcible medicating the criminals in order to ensure that they are able to regain competency so that they can be executed, could be handled. The prison department has to provide the best possible treatment to the prisoners and has to ensure that they are fully competent before being executed. In case the execution has also proceeded in which the defendant is found competent, then the defendant could be forcible medicated (in order to treat their mental condition), so that they are able to regain competence and be executed as planned. If the defendant is found to be incompetent, they should not be executed. During the trial process it is also essential that the defendant be fully competent, and in case of incompetence, they should be considered for incompetency hearing. Under no circumstances should a trial go on with an incompetent defendant. Suppose the defendant has proved to be incompetent during the process of the crime, then he should not be punished or sentenced, as the mental guilt to harm others has not existed.
References
- Howard V. Zonanna. “Competency to Be Executed and Forced Medication: Singleton v. Norris.” J Am Acad Psychiatry Law 31:372–6, 2003 http://www.jaapl.org/cgi/reprint/31/3/372.pdf
- Kathy Swedlow. “Forced Medication of Legally Incompetent Prisoners: A Primer.” American Bar Association. 30 Apr 2008. http://www.abanet.org/irr/hr/spring03/forcedmedication.html
- Marvin H. Firestone. Et al.: Psychiatric Patients and Forensic Psychiatry.” In. S. Sandy Sanbar Et al. Legal Medicine. St. Louis: Mosby, 3rd Ed, (1995).
- Steven B. Bisbing. Et al. “Competency, capacity, and immunity.” In. S. Sandy Sanbar Et al. Legal Medicine. St. Louis: Mosby, 3rd Ed, (1995).
- Ty Alper. ‘Lethal Injection Litigation Is Exposing More Than Torturous Executions.’ Capital Cases. 30 Apr 2008.
- http://www.nacdl.org/public.nsf/01c1e7698280d20385256d0b00789923/88b3d819d01e4db485257210005bd4d7?OpenDocument
