Dusky vs United States
US Supreme Court Case, 1960
Held:
The accused has sufficient present ability to:
- consult with his lawyer with a reasonable degree of rational under-
standing and
- whether he has a rational as well as a factual understanding of the proceedings against him
What is the legal definition of fitness in Illinois?
– A defendant is unfit if, because of his mental or
physical condition, he is unable to understand the nature and
purpose of the proceedings against him or to assist in his
defense.
People vs Stahl
Supreme Court of IL, 2014
Stahl: upset w/ gf, held hostage in basement then shot himself in the face. Did not recall event and could not form new memories due to brain damage from GSW
Held: incompetent, not JUST because of amnesia for events around crime but because also unable to form new memories –> limits ability to help defense, understand proceedings
US vs Verdino
US District Court, 2010 (Dr Dinwiddie testified)
Guy w/ CP, had “factual” understanding of proceedings in that could parrot back facts about court proceedings but lifelong inability to manage finances, live independently. Want to avoid trial but also not plead guilty, also not register as sex offender. Limited ability to RATIONALLY make sense of court proceedings –> not fit.
Wilson v United States:
– US Court of Appeals for DC, 1968
- Robbery and theft, crashed car in MVA w/ complete amnesia for events
- Determined that amnesia ALONE not enough to say incompetent (when weight of evidence is sufficient that defendant not NEEDED to recount events)
- Violates 6th ammendment - right to council
- Violates 14th ammendment- Due process, equal protection
“Will son, you clearly did it so don’t matter if you don’t remember”
Godinez v Moran:
– US Supreme Court, 1993
- Man who shot two ppl and ex wife charged w/ murder, facing death. Found competent to stand trial. Decides to waive council, then sentenced to death. Was grieving, perhaps proceeded this way because wanted to die.
- Question raised of whether competence to waive council and plead guilty should have higher standard than competence to stand trial. Decided no. Competence to waive is NOT the same as competence to rep self, but have right to do so.
“Go die vs Morans who rep self = get death penalty. But have a right to be a Moran and waive counsel”
Cooper v Oklahoma:
US Supreme Court, 1996
- Oklahoma: requires “clear and convincing evidence” that someone is unfit to declare incompetent to stand trial. Thus, one may stand trial even though it is more likely than not that he is incompetent. Case w/ murder of elderly man committed during course of burglary. Conflicting accounts by psychologists as to competence. Attorney brought up issue of competence multiple times in a/w talking to self, fearful of attorney. Judge still found competent, sentenced to death.
- State higher level of evidence increases risk of trying someone who is NOT competent. This denies the fundamental constitutional right to a fair trial. Risk of using preponderance of evidence is relatively less, and harm w/ NOT trying someone who is malingering is less than sentencing one who is incompetent.
- -> thus, competence to stand trial is at level of preponderance of evidence
- Civil commitment DOES require a higher standard because infringing on person’s right to liberty
- Can use clear and convincing standard for insanity because not infringing on Liberty
“Coop = COMPetent to stand trial in OKlahoma –> keep low” standard of evidence…
Jackson V Indiana:
- US Supreme Court, 1971
- Plaintiff who was “deaf, mute, mentally defective” and committed robbery. Per Indiana law, if found incompetent would be committed until found sane. Court ruled that using lower standard for commitment than that in civil case and a higher standard than civil for release deprived Liberty…
- Violates equal protection because standards are higher than for those not charged w/ a crime
- Violates due process because indefinitely commits solely on basis of being unfit to stand trial
- It IS okay to keep for reasonable period (maybe 30-90d, exact time is left up to the state) to determine if restorable
- If not ever going to be competent, typical path would be civil commitment (80-90% of ppl ARE restorable)
Indiana vs Edwards (Edwards)
- US Supreme Court, 2008
- Robbery + shooting, charged w/ attempted manslaughter. H/o schizophrenia. Found competent to stand trial but denied request to rep self.
- Court upheld states right to deny request to rep self when not believed competent to do so.
- Judge needs good reason to override finding of competence
- Have to do so knowledgeably (competent), intelligently (sort of thrown out) and voluntarily /
- Don’t need a separate competence/psych eval to waive attorney, just have to discuss with judge
Washington v. Glucksberg
1997, US Supreme Court
Held that MD assisted suicide is illegal.
“Poisoned Washington apples or a Glock for assisted suicide by Dr Glucksberg”
Canterbury v Spence
D.C. 1972)
Sum: 19yo w/ inter scapular back pain, concern for disc compression. Has laminectomy, found to have swollen cord, unable to pulsate w/ venous mass at site. Recovering well post op, then falls in hospital. About 1-2hrs later, total paralysis from waist down. Eventual residual pain, immobility, urinary and bowel incontinence. MD did not warn about risk of paralysis because felt risk was so low, was not significant.
Held: MD obligated to inform patient of risks/benefits of treatment and no treatment. And there is an obligation to at least provide minimum information.
Kaimowitz v DMH
= Consent and research/detainees
Re obtaining consent to perform experimental brain surgery (“psychosurgery”) on a pt involuntary committed as a “Criminal Sexual Psychopath.”
Sum: patient at MI MH facility murdered, then raped a student nurse. Later, experimental procedure to relieve aggression proposed. Pt was only subject deemed suitable.
Held: involuntary patients cannot consent to procedure that is experimental without compelling state interest. CAN consent to accepted medical treatment and could conceivably consent IF there was a considerable state interest (i.e. If there was a plague and involuntary patients volunteered for an experiment and potentially could save thousands of children)
“Okay mo wits” - informed consent to psychosurgery w/ involuntary patients
Cruzan v. Director Missouri Dept. of Health
US Supreme Ct, 1990
Facts: Nancy Cruzan was in a MVA, leaving her in a persistent vegitative state w/ only primitive reflexes but no higher cognitive fxn. Parents request to w/draw feeding and hydration, which would ultimately result in death. Roommate had heard her state she woudln’t want to live unless at least halfway fxnl. Court refused stating they did not have to decide this on behalf on parents, only if individual them self requests?
Held: constitutional for Missouri to require clear and convincing evidence to withdraw life sustaining treatment
Court has an investment in NOT withdrawing life sustaining treatment because decision is FINAL and not reversible if gotten wrong and impossible to know if substituted judgment of parents would be what she wanted
“Cruise on on life support” without clear and convincing evidence
Rennie v Klein
1983, Supreme Court
- John Rennie hospitalized 12x, being held involuntarily. New Jersey class action against the hospital claiming that he had a constitutional right to refuse antipsychotic drugs. Appeal court agreed based on least intrusive means standards. Then went to Supreme Court, who said does have right to refuse but must consider based on whether treatment was standard of care rather than least intrusive means (given recent ruling in another case, Romeo, stating unless actions of medical professional deviated so much from standard of care, could not reverse medical decisions).
- *Significance: involuntary patients CAN refuse meds and must have risk of harm and separate due process (hearing) to force involuntary meds.
Rogers v Commissioner
Supreme Court Mass., 1983
- Summ: Class action by involuntary patients at mental hospital. Found that patient must be found incompetent via judicial hearing prior to forced treatment in non-emergency scenarios. Not presumed incompetent by default if committed involuntarily.
- If found incompetent, treatment plan approved by judge via hearing and not by medical personnel at facility
Washington v Harper
1990 US Supreme Court
- Petitioners challenged a decision that held a Washington policy that did not provide a judicial hearing before the involuntary administration of medication violated inmates’ constitutional rights.
- Summ: Supreme Court disagreed, held that forced medication of inmates did NOT require a judicial hearing given appropriate procedural system in place (which this institution did have)
Most prisons now have procedures in place that would comply w/ this decision:
Can drug inmates against their will if a physician determined the inmate needed the medication, suffered from a mental disorder, and was gravely disabled or presented a risk of serious harm to himself or others. (NOT just behavioral
Procedure:
- Inmates who refused to take the medication voluntarily could request a hearing before a special committee (composed of non-treating psychaitrist, psychologist, Assistant superintendent) to review the decision. Inmates had a right to attend the hearing, present evidence, and cross-examine the witnesses. ALso could appeal decision to superintentant within 24hrs after hearing. Continuous treatment could only occur with periodic review (q14d) and entitled to new hearing every 180 days.
“Harp on procedure in Washington”
Riggins v Nevada
1992 US Supreme Court:
- Riggins wanted to be off of antipsychotics during trial so mental state would be more evident to jury. Convicted of murder and robbery. Appeal court refused request.
- Appealed to Supreme Court, which held that Riggins did NOT have to take antipsychotics, and forcing this violated his right to a fair trial
(Could not force meds given that state did NOT show that antipsychotic medication was medically appropriate that it considered least intrusive means in obtaining its goal of trying Riggins. If they HAD, could consider forcing meds)
Sell v US
2003, US Supreme Court
Sum: Mentally ill dentist, found incompetent due to mental illness. Trial initially approved involuntary treatment based on dangerous criteria. Appeal court held that Sell wasn’t dangerous, but could be treated to restore competency.
–> Supreme Court held that yes, if significant interest in getting defendant to trial, state can enforce involuntary treatment on grounds of competence restoration alone.
Application of President & Directors of Georgetown
DC Court of Appeals, 1964
- Court can override objection to transfusion on religious grounds
- Ms Jones, 25yo mother of 7 mo old, and her husband refused blood transfusions on religious grounds. First request for court order was denied. Appealed.
- Appellate judge presented to hospital, spoke with physicians. Saw patient. Ultimately MDs asked husband to consent and he could not on religious grounds. Judge signed order allowing transfusion
- Noted Ms Jones was in no state to consent. Applied logic as if Ms Jones were child.
