Blaithin MacMahon '03

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.

References

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. New York Times.

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