The Supreme Court, in 1986, ruled that according to
the Eight Amendment a legally insane, which is not the same as being mentally
ill, prisoner could not be executed because it is “cruel and unusual
punishment”(Davison and Neale, p539). This has now created another issue
because legally mental patients have the right to treatment, the right to the
least restrictive treatment, and the right to refuse treatment. It is this last
right that is the focus with mentally ill patients on death row: Can the state
force this same kind of prisoner to take medication to become sane enough for
execution?
Horace Kelly was convicted for three crimes and sentenced for death for
all three. When his case went to trial for the last two murders 1988 he plead
guilty by insanity. He was also found legally insane. At the time of his
conviction “the testimony of psychiatrists and a clinical psychologist
revealed that Kelly suffered from ‘a psychotic-like disturbance,’
‘impaired intellectual ability of some kind,’
‘attention-deficit disorder’ and ‘a schizotypal personality
disorder in conjunction with a moderate degree of brain damage.’ They
also confirmed his borderline intelligence and learning disabilities” (Grinfeld
1998) Yet still he was sentenced to death for
his crimes, despite the 1986 decision. Apparently the jury focused on the
psychologist who stated that when playing Tic Tac Toe with the defendant he was
able to beat her three times (Grinfeld 1998).
In April of 1998 his lawyers argued that
his mental health had deteriorated to such an extent that he was no longer fit
for execution. The prisoner guards
said that Horace would hoard his feces and smear them on the walls. He
experienced delusions and hallucinations. His execution set for April 14, 1998
was postponed (GrinFeld 1998). His execution was finally halted by the
California Supreme Court (Anonymous 1998).
The case involving
Charles Laverne Singleton took the issue of executing the mentally ill one step
further. The United States Court of Appeals for the Eight Circuit in St. Louis
ruled 6-5 that officials in Arkansas can now force a prisoner to take anti-psychotic
medication to make him sane enough to execute. However, with this slight majority
ruling there are many hotly debated issues at stake in this decision (Liptak
2003).
The
U.S Supreme Court has held that prisoners may be forced to take anti-psychotic
medications to ensure that they are competent to stand trial. Nonetheless,
these prisoners are also entitled to a hearing to consider the medical
appropriateness of the treatment, the risk the defendant poses to himself and
others, and the drugs effect on the defendants appearance, testimony, and
communications with his lawyers (Liptak 2003).
In the Atkins v
Virginia decision in 2002, six justices of
the U.S. Supreme Court ruled it is unconstitutional to execute the mentally
retarded. This too has brought up more ethical issues. From the American
Medical Association and APA position members have argued that physicians should
not participate in capital punishment. But it has also argued that the
evaluation of a death row inmate's competency to be executed is an unethical
form of participation (the Physicians of Human Rights position). “If it
is now unconstitutional to execute the mentally retarded, it is certainly
reasonable for abolitionists to begin to argue that it is equally
unconstitutional to execute the mentally ill. From a biopsychosocial
perspective, primary mental retardation and significant Axis I disorders have
similar etiological characteristics” (Stone 2002). As of now, the U.S
Supreme Court has not ruled on the execution of the mentally ill (Liptak 2003).
In Singleton’s case, Judge Roger L
Wollam, member of the Federal Appeals Court in favor of the decision, said that
the court did not need to consider the eventual outcome of this decision.
“Singleton presents the court with a choice between involuntary
medication followed by an execution and no medication followed by psychosis and
imprisonment” (Liptak 2003) Arkansas officials argue that Singleton needs
medication because he is a danger to himself and others. As the first choice is usually
beneficial to the prisoner under normal circumstances, Wollam said that it was
unfortunate that the outcome means execution in this circumstance. But if it is
based on that he is a danger to himself, medicated him to kill him is a danger
to his person also (Liptak 2003). He is already locked behind bars, refrained
from hurting others.
In opposition,
Judge Gerald W. Heany argued, “that to execute a man who is severely
deranged without treatment and arguably incompetent when treated is the
pinnacle of what Justice Marshall called ‘the barbarity of exacting
mindless vengeance” (Liptak 2003). He asserted that medicated sanity was
not the same as true sanity. The
medication does not cure the patient it only relieves symptoms- the opposing
Judges Heany and Wollam argue over whether this is sanity (Liptak 2003).
Singleton’s
lawyers argue that forcible medication “becomes illegal once execution
date is set because it is no longer in his best medical interests”(Liptak
2003). Judge Heany also recognized the ethical issue presented to doctors,
“this leaves those doctors who are treating psychotic, condemned
prisoners in an untenable position: treating the prisoner may provide short
term relief but ultimately results in his execution, whereas leaving hum
untreated will condemn him to a world such as Singleton’s, filled with
disturbing delusions and hallucinations” (Liptak 2003). It is for this
reason that Heany wished to offer Singleton a third option: medication without
fear of execution. Singleton in
the past has both voluntarily taken his medication and been forced to,
suggesting that he is not avoiding it now for the sole purpose of avoiding
medication (Liptak 2003).
Jeffery Marx
Rosenzweig is considering taking this case to the Supreme Court. He wonders
“to what extent can a government take invasive, involuntary action using
medical personnel, who are sworn to heal, save, and treat when the result of
the medical application and experience is not healing, treating and saving, but
instead has the result of causing execution”(Liptak 2003). Dr. Howard
Zonana, professor of psychiatry and law at Yale, answers that the American
Medical Association’s ethical guidelines prohibit giving medical
treatment for the purpose of executing them (Liptak 2003).
Kelly Kristine
Hill of the Arkansas attorney general’s office representing the state
only offered this: “ the ethical decisions involving doctors are
difficult ones but they are no ones for the courts” (Liptak 2003). Her argument falls short: if it is
against the ethical code for doctors to medicate a patient on death row for the
purpose of killing him, who is left to medicate this prisoner? These ethical
decisions are exactly the questions to be raised by the courts. As in this
case, as well as other cases involving mentally ill patients on death row,
juries, judges, and attorneys need to be educated as to what being mentally ill
means and the ethical rules limited doctors from carrying out legal
decisions. Such issues are not
black and white, and when decisions are made all implications need to be
considered. It is the duty of psychologists to inform the public and the
government about mental illness.
Supreme Court
Halts Execution of Mentally Ill Inmate (1998, July). Retrieve April 18, 2003, from http://www.psychiatrictimes.com/p980709.html
Davison, G and Neale, J (2001) Abnormal
Psychology Eight Edition
New York: John
Wiley & Sons, Inc
Grinfeld, M (1998, June) Executing the Mentally Ill: Did
Hearing on Inmate’s Fate Serve Justice, Morality? Psychiatric Times Vol. XV Issue 6. Retrieved April 18, 2003, from
http://www.psychiatrictimes.com/p980640.html
Liptak, A (2003, February 11) State
Can Make Inmate Sane Enough to Execute
Stone, A (2002) Supreme Court Decision Raises New Ethical
Questions for Psychiatry Psychiatric Times
Vol. XIX Issue 9. Retrieved April 20, 2003, from
http://www.psychiatrictimes.com/p020901b.html