Background
During the early hours of November 20, 1987, David Riggins went to the Nevada apartment of Paul Wade, who was later found stabbed to death. Approximately two days later, Riggins was arrested for the capital murder and robbery of Wade. After his arrest he complained of hearing voices and sleeplessness, telling the jail psychiatrist that he had taken Mellaril in the past. The psychiatrist prescribed him increasing doses of Mellaril at Riggins' request, until Riggins was taking 800 milligrams a day, considered a very high dose of that medication. [2] [1]
Riggins was evaluated and found competent to stand trial, with one of the three evaluating psychiatrists dissenting. Riggins stated he planned to present an insanity defense and requested that the Mellaril be discontinued until after the trial so that the jury would see his mental state first hand rather than be given a false impression induced by the medication, which would deny him due process. The court heard testimony from three psychiatrists with differing opinions and then gave a one-page decision denying Riggins' request but giving no rationale for the denial.
At trial, Riggins presented an insanity defense and testified on his own behalf. He indicated that, on the night of Wade's death, he used cocaine before going to Wade's apartment. Riggins admitted fighting with Wade, but claimed that Wade was trying to kill him and that voices in his head said that killing Wade would be justifiable homicide. A jury found Riggins guilty of murder with use of a deadly weapon and robbery with use of a deadly weapon. After a penalty hearing, the same jury sentenced him to death. [1]
Appeals
Riggins appealed to the Nevada Supreme Court on the grounds that forced administration of Mellaril denied him the ability to assist in his own defense and gave a false impression of his attitude, appearance, and demeanor at trial. [1] Riggins claimed that the forced medication was not justified, as the State had not demonstrated a need to administer Mellaril nor did it explore less restrictive alternatives to giving him 800 milligrams of the drug each day. However, the Nevada Supreme Court affirmed Riggins' convictions and death sentence. Riggins then petitioned the U.S. Supreme Court. [1]
Opinion of the Court
The Supreme Court reversed and remanded, holding that forced administration of antipsychotic medication during Riggins' trial violated his rights guaranteed under the Sixth and Fourteenth Amendments. [1] A seven-member majority held that the state did not show that antipsychotic medication was medically appropriate and did not demonstrate that it considered less intrusive means in obtaining its goal of trying Riggins. [1]
The Court stated that Riggins' Eighth Amendment argument that the forcible administration of antipsychotic medication denied him the chance to show the jury his true mental state at the sentencing hearing was not raised in the petition for certiorari and therefore was not addressed by the court. [1]
The Court held that a person awaiting trial has a valid reason, protected under the due process clause, to refuse antipsychotic drugs, referencing Washington v. Harper (1990) and Bell v. Wolfish (1979). Therefore, once Riggins' requested termination of the medication, the State was obligated to establish both the need for the antipsychotic drug and its medical appropriateness for Riggins' safety and that of others as the less restrictive alternative available. If the state had done this, due process would have been satisfied. The State might have been able to justify the treatment, if medically appropriate, if it set forth that the adjudication of guilt or innocence could not be established by using less intrusive means. Since the trial court did not do this and allowed the drug's administration to continue without making any of the determinations stated above, it is very likely that this error violated Riggins' trial rights established by the Constitution. However, this is only speculative as there is no way to know what the outcome would have been if the proper course had been followed. [1]
Significance
This decision highlighted two factors not previously emphasized in cases involving involuntary medication. First, the involuntary treatment must be the least intrusive treatment for restoration of competence. Second, the proposed treatment must be medically appropriate for the individual's safety as well as that of others. [3]
In Washington v. Harper , the individual protesting the involuntary medication was already incarcerated. The Court suggested in this case that a competent person has the right to refuse if the medication is administered for other than treatment reasons to a person not dangerous or extremely ill, but it accepted the institution's procedures for making such treatment decisions. However, Riggins was not convicted at the time he was involuntarily medicated. In Riggins v. Nevada, the Court said that not only had the medication to be a medically appropriate means of attaining an important state objective such as competency, but the medication must be the least intrusive means of attaining the objective. However, although the treatment must be the least intrusive (for example, to allow the individual to retain a clear head to consult with his attorney as well as to avoid medication side effects), the court did not say that involuntary medication is never appropriate to achieve the state's goal. [2]
The insanity defense, also known as the mental disorder defense, is an affirmative defense by excuse in a criminal case, arguing that the defendant is not responsible for their actions due to a psychiatric disease at the time of the criminal act. This is contrasted with an excuse of provocation, in which the defendant is responsible, but the responsibility is lessened due to a temporary mental state. It is also contrasted with the justification of self defense or with the mitigation of imperfect self-defense. The insanity defense is also contrasted with a finding that a defendant cannot stand trial in a criminal case because a mental disease prevents them from effectively assisting counsel, from a civil finding in trusts and estates where a will is nullified because it was made when a mental disorder prevented a testator from recognizing the natural objects of their bounty, and from involuntary civil commitment to a mental institution, when anyone is found to be gravely disabled or to be a danger to themself or to others.
Forensic psychiatry is a subspeciality of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment." A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment, such as medications and psychotherapy, to criminals.
The Lanterman–Petris–Short (LPS) Act regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman (R) and California State Senators Nicholas C. Petris (D) and Alan Short (D), and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing, psychology and social work. The demand for emergency psychiatric services has rapidly increased throughout the world since the 1960s, especially in urban areas. Care for patients in situations involving emergency psychiatry is complex.
In United States and Canadian law, competence concerns the mental capacity of an individual to participate in legal proceedings or transactions, and the mental condition a person must have to be responsible for his or her decisions or acts. Competence is an attribute that is decision-specific. Depending on various factors which typically revolve around mental function integrity, an individual may or may not be competent to make a particular medical decision, a particular contractual agreement, to execute an effective deed to real property, or to execute a will having certain terms.
Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.
James Barry "Jim" Gottstein is a mostly retired Alaska based lawyer who practiced business law and public land law, and is well known as an attorney advocate for people diagnosed with serious mental illness. Gottstein has sought to check the growth in the administration of psychotropics, particularly to children.
Sell v. United States, 539 U.S. 166 (2003), is a decision in which the United States Supreme Court imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the sole purpose of making them competent and able to be tried. Specifically, the court held that lower courts could do so only under limited circumstances in which specified criteria had been met. In the case of Charles Sell, since the lower court had failed to determine that all the appropriate criteria for court-ordered forcible treatment had been met, the order to forcibly medicate the defendant was reversed.
Rennie v. Klein, 462 F. Supp. 1131, was a case heard in the United States District Court for the District of New Jersey in 1978 to decide whether an involuntarily committed mental patient has a constitutional right to refuse psychiatric medication. It was the first case to establish that such a patient has the right to refuse medication in the United States.
Washington v. Harper, 494 U.S. 210 (1990), was a United States Supreme Court case in which an incarcerated inmate sued the state of Washington over the issue of involuntary medication, specifically antipsychotic medication.
Foucha v. Louisiana, 504 U.S. 71 (1992), was a U.S. Supreme Court case in which the court addressed the criteria for the continued commitment of an individual who had been found not guilty by reason of insanity. The individual remained involuntarily confined on the justification that he was potentially dangerous even though he no longer suffered from the mental illness that served as a basis for his original commitment.
Jackson v. Indiana, 406 U.S. 715 (1972), was a landmark decision of the United States Supreme Court that determined a U.S. state violated due process by involuntarily committing a criminal defendant for an indefinite period of time solely on the basis of his permanent incompetency to stand trial on the charges filed against him.
Perry v. Louisiana, 498 U.S. 38 (1990), was a United States Supreme Court case over the legality of forcibly medicating a death row inmate with a mental disorder, to render him competent to be executed.
Godinez v. Moran, 509 U.S. 389 (1993), was a landmark decision in which the U.S. Supreme Court ruled that if a defendant was competent to stand trial, they were automatically competent to plead guilty, and thereby waive the panoply of trial rights, including the right to counsel.
Addington v. Texas, 441 U.S. 418 (1979), was a landmark decision of the US Supreme Court that set the standard for involuntary commitment for treatment by raising the burden of proof required to commit persons for psychiatric treatment from the usual civil burden of proof of "preponderance of the evidence" to "clear and convincing evidence".
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit considered whether a person diagnosed with mental illness committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency conditions.
Kathryn Faughey was a 56-year-old New York City psychologist who was murdered by 39-year-old David Tarloff at her Upper East Side office on the night of February 12, 2008.
Bodily integrity is the inviolability of the physical body and emphasizes the importance of personal autonomy, self-ownership, and self-determination of human beings over their own bodies. In the field of human rights, violation of the bodily integrity of another is regarded as an unethical infringement, intrusive, and possibly criminal.
This disability rights timeline lists events relating to the civil rights of people with disabilities in the United States of America, including court decisions, the passage of legislation, activists' actions, significant abuses of people with disabilities, and the founding of various organizations. Although the disability rights movement itself began in the 1960s, advocacy for the rights of people with disabilities started much earlier and continues to the present.
The following outline is provided as an overview of and topical guide to psychiatry:
