Court Allows State to Medicate Death-Row Inmate Forcibly

In its February ruling the appeals court weighed the competing interests of Singleton in avoiding being forced to take medication that paves the way for his execution against the government’s interest in punishing offenders whose crimes are so heinous they qualify for the death penalty.

The court decided that not only does Singleton have a history of wanting to take the powerful drugs rather than remaining psychotic, but also he “has suffered no substantial side effects” from the drugs.

On these facts, the majority decided, “the state’s interest in carrying out its lawfully imposed sentence is the superior one.”

(The development of such side effects was part of the U.S. Supreme Court’s reasoning in the 1992 Riggins v. Nevada case, which established limits on a state’s ability to medicate a mentally ill prisoner involuntarily. States were to first seek less-intrusive alternatives and then to medicate only if the safety of the patient or others was at risk.)

The appeals court did acknowledge that there is no less-intrusive treatment for alleviating Singleton’s psychosis, but that the potential side effects “do not overwhelm the benefits of the medicine.”

The court also looked at Singleton’s argument that while taking the medication may be in his “best medical interest,” being executed is not, and it is the only “unwanted consequence of the medication.”

The majority disagreed with this argument, however, saying that in this case “the best medical interests of the patient must be determined without regard to whether there is a pending date of execution,” thus allowing the state to medicate him forcibly. They added that “since states have the right to interpret their constitutions as they see fit,” they elected to not undertake an inquiry of the state’s motives in wanting to medicate Singleton beyond its desire to provide required medical care. That is, they did not evaluate whether the state’s primary motive was punitive rather than medical, which would likely be interpreted as unconstitutional.

The court’s ultimate conclusion was that a state does not violate a prisoner’s Eighth Amendment protections against cruel and unusual punishment “when it executes a prisoner who became incompetent during his long stay on death row but who subsequently regained competency through appropriate medical care.”

The dissenting minority’s opinion, however, emphasizes that “to execute a man who is severely deranged without treatment, and arguably incompetent when treated, is the pinnacle of what Justice Marshall [in Ford v. Wainwright] called ‘the barbarity of exacting mindless vengeance.’ ”

They cited Supreme Court cases, “the overwhelming majority of scholarly commentary, and the ethical standards of the medical profession” in concluding that the majority justices’ ruling was wrong.

The dissenting justices also distinguished between being cured and having symptoms masked by medication. They noted that the latter situation characterized Singleton and that no authorities claim that antipsychotics cure schizophrenia. “One of the pitfalls of equating true sanity with its medically coerced cousin,” they said, “is that drug-induced sanity is temporary and unpredictable” and that the drug may affect the individual differently each time it is administered. In Singleton’s case, the medications he took have never kept him free of schizophrenia symptoms, they pointed out.

Regarding the majority’s refusal to examine the state’s motives, the dissenting justices concluded, “At the very least, setting an execution date calls into question the state’s motivation for administering the medication.” Once that date was set, the argument that medicating him was in his medical interest evaporated, they maintained.

Should psychiatrists be asked to participate in these end-stage, death-penalty decisions, Zonana strongly urged them to “not feel overly pressured by state governments to do things that are personally or professionally unacceptable.” ▪